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一项来自临终关怀研究合作网络的探索性研究,旨在改善某一地区不同种族社区的医疗服务可及性。

Exploratory study from an end-of-life research partnership network to improve access for ethnically diverse communities in one region.

作者信息

Cook Erica J, Tolliday Elaine, Ali Nasreen, Suleman Mehrunisha, Wilkinson Emma, Randhawa Gurch

机构信息

School of Psychology, University of Bedfordshire, Luton, England.

Keech Hospice Care, Luton, England.

出版信息

Health Soc Care Deliv Res. 2024 Dec 11:1-23. doi: 10.3310/MWHY5612.

Abstract

BACKGROUND

Minority ethnic patients are less likely to access timely and effective palliative and end-of-life care and, as a consequence, more likely to experience poorer symptom management and receive more intensive treatments at the end of life. Research activity has the potential to address the aforementioned barriers to improve access. However, there is a need to develop capacity and capability, particularly within underserved communities, to provide an infrastructure that can drive research activity informed by the community to benefit the community.

OBJECTIVE

To build and develop a robust, inclusive and representative research partnership to facilitate improved research activity committed to addressing inequity in access to palliative and end-of-life care among ethnically diverse communities.

DESIGN

An inclusive and representative KEEch research Partnership NETwork was established, comprised over 80 partner organisations that represent the local diverse and multifaith communities. Interviews ( = 11) with service providers and face-to-face roundtable workshops with community stakeholders, service providers, informal carers and faith leaders were conducted to understand needs, challenges and research priorities.

SETTING

Bedfordshire, Hertfordshire and Milton Keynes, United Kingdom.

RESULTS

Developing KEEch research Partnership NETwork required a flexible and agile approach to engage effectively with institutionalised and non-institutionalised stakeholders. Sharing a joint purpose of learning, managing partners' expectations and providing transparency and accountability within the network were all essential in building trust and equity within the research partnership. The overarching findings revealed a range of sociocultural and structural barriers that negatively impact access and experience among minority ethnic groups. Discussions centred on the disconnect between informal care and support within the community, which many ethnic minority communities rely upon, and 'institutional' medical services. KEEch research Partnership NETwork uncovered that while service providers and communities acknowledge they need to engage with each other more, they remain uncertain of the best way to achieve this. There was also consensus that services need to deliver more effective, culturally competent, person-centric care that promotes compassion and gives weight to non-medical needs to better meet the needs of the diverse population. These findings and priorities have informed the submission of a co-produced research funding proposal. Beyond that, KEEch research Partnership NETwork has also provided a platform for further unplanned spin-off research projects and collaboration, including the implementation of an innovative 'community connector' role to facilitate better integration of community and voluntary services in palliative and end-of-life care.

CONCLUSIONS

KEEch research Partnership NETwork has provided valuable insight into factors that can facilitate the successful collaboration between multifaith and diverse community stakeholders. Through KEEch research Partnership NETwork, we offer our observations as an opportunity for shared learning for others who want to adopt a similar approach when in the planning stages of establishing a research partnership network. The mutual benefit of developing this partnership and working collectively with communities to address inequalities in accessing palliative and end-of-life care could provide a useful approach and way of solving other important priorities to reduce wider health inequalities.

FUNDING

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research as award number NIHR135381.

摘要

背景

少数族裔患者获得及时有效的姑息治疗和临终关怀的可能性较小,因此,他们在临终时更有可能出现较差的症状管理,并接受更强化的治疗。研究活动有可能消除上述障碍,以改善医疗服务的可及性。然而,有必要培养能力,特别是在服务不足的社区,以提供一个能够推动基于社区的研究活动并使社区受益的基础设施。

目的

建立和发展一个强大、包容且具有代表性的研究伙伴关系,以促进开展致力于解决不同族裔社区在获得姑息治疗和临终关怀方面的不平等问题的研究活动。

设计

建立了一个包容且具有代表性的KEEch研究伙伴关系网络,该网络由80多个代表当地不同和多信仰社区的伙伴组织组成。对服务提供者进行了访谈(n = 11),并与社区利益相关者、服务提供者、非正式护理人员和宗教领袖举行了面对面的圆桌研讨会,以了解需求、挑战和研究重点。

地点

英国贝德福德郡、赫特福德郡和米尔顿凯恩斯。

结果

发展KEEch研究伙伴关系网络需要一种灵活多变的方法,以便与制度化和非制度化的利益相关者有效互动。在研究伙伴关系中建立信任和公平,分享共同的学习目标、管理合作伙伴的期望以及在网络内提供透明度和问责制都是至关重要的。总体研究结果揭示了一系列对少数族裔的医疗服务可及性和就医体验产生负面影响的社会文化和结构障碍。讨论集中在许多少数族裔社区所依赖的社区内非正式护理和支持与“机构化”医疗服务之间的脱节。KEEch研究伙伴关系网络发现,虽然服务提供者和社区都承认他们需要更多地相互合作,但他们仍然不确定实现这一目标的最佳方式。此外,大家还达成共识,即服务需要提供更有效、具有文化胜任力、以人为本的护理,促进同情心,并重视非医疗需求,以更好地满足不同人群的需求。这些研究结果和优先事项为提交一份共同制定的研究资金申请提供了依据。除此之外,KEEch研究伙伴关系网络还为进一步的非计划衍生研究项目和合作提供了一个平台,包括设立一个创新的“社区连接者”角色,以促进社区和志愿服务更好地融入姑息治疗和临终关怀。

结论

KEEch研究伙伴关系网络为促进多信仰和不同社区利益相关者之间的成功合作的因素提供了有价值的见解。通过KEEch研究伙伴关系网络,我们分享我们的观察结果,为其他在建立研究伙伴关系网络的规划阶段希望采用类似方法的人提供一个共同学习的机会。发展这种伙伴关系并与社区共同努力解决获得姑息治疗和临终关怀方面的不平等问题所带来的互利效益,可能为解决其他重要优先事项以减少更广泛的健康不平等问题提供一种有用的方法和途径。

资金来源

本文介绍了由英国国家卫生与保健研究所(NIHR)健康与社会保健交付研究独立资助的研究,资助编号为NIHR135381。

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