Why Don't Patients Enroll in Hospice? Can We Do Anything About It?
Why Don't Patients Enroll in Hospice? Can We Do Anything About It?
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DOI：
10.1007/s11606-010-1423-9
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发表时间：
2010-10-01
影响因子：
5.7
通讯作者：
Fryer-Edwards, Kelly
中科院分区：
文献类型：
--
作者：
Vig, Elizabeth K.;Starks, Helene;Fryer-Edwards, Kelly
美国临终关怀组织的目标是提供高质量的，以病人为中心的临终关怀，病人在生命的最后6个月，但这些组织中的一些观察到，一些临终关怀合格的病人谁是指临终关怀不最初enrolled.Primary objective：要确定的原因，符合条件的病人不参加临终关怀（第1阶段）。次要目的：为了确定临终关怀提供者使用的策略，以解决这些原因（第2阶段）。半结构化访谈分析使用内容分析。在第1阶段，我们采访了30名患者和/或患者的家属谁有临终关怀入院访问，但谁没有登记。在第二阶段，我们采访了19名临终关怀工作人员和国家专家。在第一阶段，我们要求参与者描述病人的疾病，临终关怀转诊，以及他们为什么没有登记。我们进行了内容分析，以描述他们不参加临终关怀的原因。在第二阶段，我们招募了临终关怀入院人员和临终关怀专家。我们要求他们描述在对潜在的新临终关怀患者进行入院访视期间，他们将如何应对每个原因（来自第1阶段）。我们确定了关键短语，并总结了他们的建议。患者未入组的原因分为三大类：患者/家属的看法（例如，“未准备好”），临终关怀特定问题（例如，适合临终关怀的患者的可变定义），以及系统问题（例如，关注护理的连续性）。临终关怀的工作人员/专家遇到了每一个原因，并提供了战略，在个人和组织层面的responsibility.In希望增加临终关怀合格的患者之间的临终关怀登记，非临终关怀和临终关怀临床医生可能要采用一些临终关怀的工作人员/专家与患者/家属谈论临终关怀的策略，并可能要熟悉自己与临终关怀组织在他们的地区之间的差异。收容所可能要重新考虑他们的入院政策和程序，根据病人和家属的看法和关注。
United States hospice organizations aim to provide quality, patient-centered end-of-life care to patients in the last 6 months of life, yet some of these organizations observe that some hospice-eligible patients who are referred to hospice do not initially enroll.Primary objective: To identify reasons that eligible patients do not enroll in hospice (phase 1). Secondary objective: To identify strategies used by hospice providers to address these reasons (phase 2).Semi-structured interviews analyzed using content analysis.In phase 1, we interviewed 30 patients and/or family members of patients who had a hospice admissions visit, but who did not enroll. In phase 2, we interviewed 19 hospice staff and national experts.In phase 1, we asked participants to describe the patient's illness, the hospice referral, and why they had not enrolled. We performed a content analysis to characterize their reasons for not enrolling in hospice. In phase 2, we enrolled hospice admissions staff and hospice experts. We asked them to describe how they would respond to each reason (from phase 1) during an admissions visit with a potential new hospice patient. We identified key phrases, and summarized their recommendations.Reasons that patients hadn't enrolled fell into three broad categories: patient/family perceptions (e.g., "not ready"), hospice specific issues (e.g., variable definitions of hospice-eligible patients), and systems issues (e.g., concerns about continuity of care). Hospice staff/experts had encountered each reason, and offered strategies at the individual and organizational level for responding.In hopes of increasing hospice enrollment among hospice-eligible patients, non-hospice and hospice clinicians may want to adopt some of the strategies used by hospice staff/experts for talking about hospice with patients/families and may want to familiarize themselves with the differences between hospice organizations in their area. Hospices may want to reconsider their admission policies and procedures in light of patients' and families' perceptions and concerns.