Carpenter Joan G, Hanson Laura C, Demiris George, Hodgson Nancy, Ersek Mary
University of Maryland School of Nursing, Baltimore, USA.
Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, USA.
BMC Geriatr. 2025 Mar 19;25(1):187. doi: 10.1186/s12877-025-05820-0.
Studies have shown that palliative care delivered to people living with dementia (PLWD) in nursing homes (NHs) improves care quality and reduces potentially burdensome treatments. However, access to palliative care services in NHs is uncommon. Telehealth may extend the reach of specialty palliative care consultation, yet strategies for feasible and acceptable NH implementation remain unknown. During implementation of an embedded pragmatic pilot clinical trial for PLWD, we aimed to describe key informants' perceptions of a NH telehealth palliative care intervention.
Guided by the Practical Implementation Sustainability Model (PRISM), we engaged key informants in 30-60-minute focus groups and individual semi-structured interviews to understand barriers and facilitators to implementation of a NH telehealth palliative care intervention in one NH. Interview prompts addressed contextual factors that influenced outcomes. Interviews were conducted and recorded via videoconference, transcribed, and analyzed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Participants (n = 14) included NH administrators and other leaders, palliative care providers, telehealth representatives, dementia advocates, a care partner, and a PLWD. Identified barriers to implementation included stigma surrounding dementia, palliative care, and NHs; multiple logistical pieces required to implement the intervention; inflexibility of palliative care providers to meet NH needs; and inability to assess residents in person. Facilitators included convenient, user-friendly and readily available telehealth equipment, and NH staff presence during visits. Outcomes most relevant to the key informants were increased goals of care conversations, improved symptom management and quality of life, and decreased health care utilization. Suggested adaptations included increased family engagement in the logistics of the intervention and strong NH advocacy.
In this study, key informants provided feedback that barriers to implementing NH telehealth palliative care far outweighed the facilitators for uptake. Future work will focus on employing NH staff in user centered design to overcome barriers such as optimal timing for consults and/or scheduled consult days to fit NH workflow, assessing organizational readiness for implementing change, and identifying dementia-specific and palliative care education needs.
研究表明，为养老院中患有痴呆症的患者（PLWD）提供姑息治疗可提高护理质量并减少潜在的繁重治疗。然而，养老院中获得姑息治疗服务的情况并不常见。远程医疗可能会扩大专科姑息治疗咨询的覆盖范围，但在养老院实施可行且可接受的策略仍不明确。在为PLWD开展一项嵌入式实用试点临床试验的过程中，我们旨在描述关键信息提供者对养老院远程医疗姑息治疗干预措施的看法。
以实用实施可持续性模型（PRISM）为指导，我们让关键信息提供者参加30至60分钟的焦点小组讨论和个人半结构化访谈，以了解在一家养老院实施远程医疗姑息治疗干预措施的障碍和促进因素。访谈提示涉及影响结果的背景因素。访谈通过视频会议进行并记录，转录后使用可及性、有效性、采用率、实施情况和维持情况（RE - AIM）框架进行分析。
参与者（n = 14）包括养老院管理人员和其他领导、姑息治疗提供者、远程医疗代表、痴呆症倡导者、一名护理伙伴和一名PLWD。确定的实施障碍包括围绕痴呆症、姑息治疗和养老院的污名化；实施干预所需的多个后勤环节；姑息治疗提供者缺乏灵活性以满足养老院的需求；以及无法亲自评估居民。促进因素包括方便、用户友好且随时可用的远程医疗设备，以及访视期间养老院工作人员在场。与关键信息提供者最相关的结果是增加了护理目标对话、改善了症状管理和生活质量，以及减少了医疗保健利用率。建议的调整包括增加家庭对干预后勤工作的参与以及养老院的大力宣传。
在本研究中，关键信息提供者提供的反馈表明，实施养老院远程医疗姑息治疗的障碍远远超过了采用的促进因素。未来的工作将集中于让养老院工作人员参与以用户为中心的设计，以克服诸如咨询的最佳时间和/或安排符合养老院工作流程的咨询日等障碍，评估组织实施变革的准备情况，以及确定针对痴呆症和姑息治疗的教育需求。
