在社区医院或临终关怀机构中死于癌症：最亲近的非专业护理人员的看法。
Dying from cancer in community hospitals or a hospice: closest lay carers' perceptions.
作者信息
Seamark D A, Williams S, Hall M, Lawrence C J, Gilbert J
机构信息
Institute of General Practice, Postgraduate Medical School, University of Exeter.
出版信息
Br J Gen Pract. 1998 Jun;48(431):1317-21.
BACKGROUND
Despite there being around 400 community hospitals in the United Kingdom, there is little published research on the quality of service provided by these hospitals.
AIM
To compare the quality of terminal cancer care in community hospitals with a hospice as assessed by patients' closest lay carer (relative or friend).
METHOD
Structured interview (or questionnaire based on the interview proforma) with closest lay carers of all patients dying over one year in 12 community hospitals in east Devon and a purpose-built hospice in the city of Exeter.
RESULTS
A total of 292 cases (176 in community hospitals and 116 in a hospice) were identified, resulting in 238 carers being eligible for interview or questionnaire survey. Overall, 106 successful interviews and 55 questionnaires were completed, giving a response rate of 67.6%. Carers gave a near unanimous vote of excellence for the total care given by the hospice, while around 40% of carers of patients in community hospitals considered that improvements were possible. Community hospitals attracted more negative comments than hospices, with criticism being directed at problems of communication, lack of nursing staff, and lack of support in bereavement. Carers of hospice patients were significantly more likely to be present at the time of death than those of community hospital patients [45/70 (64%) vs. 31/89 (35%); chi 2 = 13.6, P < 0.001], an observation possibly because nursing staff in community hospitals are less experienced at dealing with terminally ill patients and such hospitals have fewer adequate facilities.
CONCLUSIONS
Lay carers indicated great satisfaction with care given in the hospice and less satisfaction with care given in the community hospitals. However, the community hospitals are non-specialist units with far lower levels of trained staff. Improvements in terms of the communication skills of doctors and nurses, specific training for nurses in palliative care, and structured bereavement care could be made without necessarily increasing staffing numbers.
背景
尽管英国有大约400家社区医院，但关于这些医院所提供服务质量的已发表研究却很少。
目的
比较社区医院与临终关怀机构中晚期癌症护理的质量，由患者最亲近的非专业护理人员（亲属或朋友）进行评估。
方法
对东德文郡12家社区医院以及埃克塞特市一家专门建造的临终关怀机构中在一年多时间里去世的所有患者的最亲近非专业护理人员进行结构化访谈（或基于访谈提纲的问卷调查）。
结果
共识别出292例病例（176例在社区医院，116例在临终关怀机构），238名护理人员符合访谈或问卷调查条件。总体而言，完成了106次成功访谈和55份问卷，回复率为67.6%。护理人员对临终关怀机构提供的整体护理几乎一致给予高度评价，而社区医院患者的护理人员中约40%认为仍有改进空间。社区医院比临终关怀机构收到更多负面评价，批评主要集中在沟通问题、护理人员短缺以及丧亲期间缺乏支持。临终关怀机构患者的护理人员在患者死亡时在场的可能性显著高于社区医院患者的护理人员[45/70（64%）对31/89（35%）；卡方 = 13.6，P < 0.001]，这一观察结果可能是因为社区医院的护理人员在照顾绝症患者方面经验较少，且此类医院的适当设施较少。
结论
非专业护理人员对临终关怀机构提供的护理表示高度满意，对社区医院提供的护理满意度较低。然而，社区医院是非专科单位，训练有素的 staff 水平要低得多。在不必然增加 staff 数量的情况下，可以在医生和护士的沟通技巧、护士在姑息治疗方面的特定培训以及结构化的丧亲护理方面做出改进。
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