Song Jiyoun, Ramlogan Lynette, Vergez Sasha, Davoudi Anahita, Sridharan Sridevi, Cho Hannah, Stanley June, McDonald Margaret V, Bowles Kathryn H, Shang Jingjing, Stone Patricia W, Topaz Maxim
University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
VNS Health, New York, NY, USA.
Home Health Care Manag Pract. 2025 Feb;37(1):45-53. doi: 10.1177/10848223241247197. Epub 2024 Apr 15.
Palliative care offers undeniable advantages to elderly patients with multiple chronic illnesses in managed long-term care. However, only approximately 14% of those who require palliative care actually receive it. To investigate factors influencing decision-making regarding palliative care acceptance, and healthcare providers' communication strategies, which patients or family caregivers perceive during managed long-term care. Qualitative thematic content analysis study. Two data sources from home and community-based health care organization in a metropolitical city in the Northeastern United States were used: (a) retrospectively collected 79 phone call audio recordings between patients and/or family caregivers with healthcare providers when initiate palliative care option, and (b) prospectively collected 10 exploratory qualitative interviews with patients and/or family caregivers for this study purpose. From a total of 89 conversations, 7 themes emerged during palliative care decision-making: (a) capability for self-management; (b) symptom severity; (c) perceptions of chronic disease; (d) satisfaction with current health services; (e) code status; (f) caregiver burden and (g) other reasons, including financial considerations and service affiliations. In addition, from 10 qualitative interviews, 4 key themes in healthcare providers' communication that optimize palliative care conversations were indicated: (i) trust and relationship dynamics; (ii) positive reinforcement and personal connection; (iii) conversation setting and initiator; and (iv) collaborative approach to care coordination. Enhancing decision-making around palliative care and improving acceptance of palliative care services may be improved through the integration of personalized care plans, empathetic communication, use of symptom-inclusive assessments for timely care, and proactively addressing caregiver burden.
姑息治疗为长期管理式照护中的患有多种慢性病的老年患者带来了不可否认的益处。然而，真正接受姑息治疗的患者仅占需要姑息治疗患者的约14%。本研究旨在调查影响姑息治疗接受决策的因素，以及在长期管理式照护中患者或家庭照护者所感知到的医疗服务提供者的沟通策略。采用定性主题内容分析法进行研究。使用了美国东北部一个大城市的家庭和社区医疗保健组织的两个数据源：（a）回顾性收集的79段患者和/或家庭照护者与医疗服务提供者在启动姑息治疗选项时的电话录音，以及（b）前瞻性收集的10段针对本研究目的对患者和/或家庭照护者进行的探索性定性访谈。在总共89次对话中，出现了姑息治疗决策过程中的7个主题：（a）自我管理能力；（b）症状严重程度；（c）对慢性病的认知；（d）对当前医疗服务的满意度；（e）医疗急救状态；（f）照护者负担；以及（g）其他原因，包括经济考虑和服务归属。此外，从10次定性访谈中，还指出了医疗服务提供者沟通中优化姑息治疗对话的4个关键主题：（i）信任和关系动态；（ii）积极强化和个人联系；（iii）对话环境和发起者；以及（iv）协作式护理协调方法。通过整合个性化护理计划、共情沟通、使用包含症状的评估以实现及时护理，以及积极解决照护者负担，可能会改善围绕姑息治疗的决策制定并提高姑息治疗服务的接受度。
