Fox Siobhan, Drennan Jonathan, Guerin Suzanne, Kernohan W George, Murphy Aileen, O'Connor Niamh, Timmons Suzanne
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
School of Nursing and Midwifery, University College Cork, Cork, Ireland.
BMC Palliat Care. 2025 May 22;24(1):143. doi: 10.1186/s12904-025-01701-w.
As dementia is a life-limiting illness, it is now widely accepted that people with dementia benefit from palliative care. The core components of palliative care for people with dementia have been suggested, however little is known about what an effective dementia palliative care service looks like in practice. While some services exist, a lack of description and scant detail on how and why they work makes it difficult for others to learn from existing successful models and impedes replication. Accordingly, we set out to describe an effective dementia palliative care service using programme theory, and to visually represent it in a logic model.
This was mixed-methods study. An exemplary dementia palliative care service, which cares for people with advanced dementia in their own home in the last year of life, had been identified from a previous survey. The development of the programme logic model was informed by interviews with staff (n = 6), staff surveys (n = 1), service user surveys (n = 10) and the analysis of secondary data sources including routinely collected service data.
The logic model and summary results explain in detail how this dementia palliative care service undertook activities relating to person-centred care, carer support, end-of-life care, accessible care, timely care, and integrated care. It maps each activity to specific outputs and outcomes, showing that dementia palliative care, when provided appropriately, can greatly improve the quality of care received by people living and dying with advanced dementia, and their families, in the community.
The logic model presented may support those developing dementia palliative care services, or guide others running existing services in how to systematically present their service activities to others, and demonstrates how clinicians, policy-makers, and others involved in service planning can utilise logic models to design new services and improve existing services.
由于痴呆症是一种会影响寿命的疾病，目前人们普遍认为痴呆症患者能从姑息治疗中受益。虽然已经提出了针对痴呆症患者的姑息治疗的核心组成部分，但对于有效的痴呆症姑息治疗服务在实际中是什么样的却知之甚少。尽管存在一些服务，但对其运作方式和原因缺乏描述且细节很少，这使得其他人难以借鉴现有的成功模式，也阻碍了复制。因此，我们着手使用项目理论来描述一种有效的痴呆症姑息治疗服务，并在逻辑模型中直观地呈现它。
这是一项混合方法研究。从之前的一项调查中确定了一个示范性的痴呆症姑息治疗服务项目，该项目在患者生命的最后一年为患有晚期痴呆症的患者在其家中提供护理。通过对工作人员的访谈（n = 6）、工作人员调查（n = 1）、服务使用者调查（n = 10）以及对包括常规收集的服务数据在内的二手数据源的分析，为项目逻辑模型的开发提供了信息。
逻辑模型和总结结果详细解释了这种痴呆症姑息治疗服务是如何开展与以患者为中心的护理、照顾者支持、临终护理、可及护理、及时护理和综合护理相关的活动的。它将每项活动映射到特定的产出和结果，表明适当提供痴呆症姑息治疗可以极大地提高晚期痴呆症患者及其家人在社区中接受的护理质量。
所呈现的逻辑模型可能会支持那些开发痴呆症姑息治疗服务的人，或者指导其他运营现有服务的人如何向他人系统地展示其服务活动，并展示临床医生、政策制定者和其他参与服务规划的人如何利用逻辑模型来设计新服务和改进现有服务。
