Is there no place like home? Caregivers recall reasons for and experience upon transfer from home hospice to inpatient facilities
Is there no place like home? Caregivers recall reasons for and experience upon transfer from home hospice to inpatient facilities
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DOI：
10.1089/jpm.2006.9.100
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发表时间：
2006-02-01
影响因子：
2.8
通讯作者：
Tulsky, James A.
中科院分区：
文献类型：
--
作者：
Evans, Wendy G.;Cutson, Toni M.;Tulsky, James A.
目的：描述照顾者从家庭临终关怀中心转到住院机构的原因、对护理地点和死亡地点的偏好以及在这些转院过程中的经历。设计：对已转院的已故临终关怀患者的照顾者进行回顾性定性分析。地点：一所大学附属的社区临终关怀提供者。研究对象：在2003年1月至2004年2月期间，已去世的临终关怀患者转到急诊医院、独立的住院临终关怀机构或疗养院的照顾者。测量：制定半结构访谈方案并用于所有访谈。采用扎根的理论方法对转院的原因、护理地点和死亡地点的偏好以及转院时的经历进行编码。结果：由于急性医疗事件、症状失控、即将死亡或无法在家中安全地提供所需护理而转院的患者。尽管所有照顾者都表示强烈倾向于在家中护理，但其他方面的担忧，如疼痛和症状控制、安全性以及生活质量和数量，随着时间的推移变得更加重要。我们发现，在护理和死亡地点方面的特定偏好存在显著差异。转运机构的护理满意度取决于明确护理目标、遵循治疗偏好、提供个性化护理和患者的环境。结论：临终关怀患者通常转到设施以完成与良好的临终关怀相一致的目标。我们可以通过将患者和他们的照顾者视为独特的个体来改善他们的体验，探索和尊重治疗偏好，并创造一个愉快的物理环境。
Objective: To describe caregivers' reasons for transfer from home hospice to inpatient facilities, preferences for site of care and death, and their experiences during these transfers.Design: Retrospective qualitative analysis of interviews with caregivers of deceased hospice patients who had undergone transfer.Setting: A university-affiliated community hospice provider.Subjects: Caregivers of deceased hospice patients who transferred to an acute care hospital, a freestanding inpatient hospice facility, or a nursing home while enrolled in hospice and died between January 2003 and February 2004.Measurements: A semistructured interview protocol was developed and used for all interviews. Interviews were coded for reasons for transfer, preferences for site of care and death, and experience upon transfer using a grounded theory approach.Results: Patients transferred because of an acute medical event, an uncontrolled symptom, imminent death, or inability to provide needed care safely at home. Although all caregivers expressed a strong preference for care at home, other concerns such as pain and symptom control, safety, and quality and quantity of life became more important with time. We found significant variation in specific preferences regarding care and site of death. Satisfaction with care at the transfer facilities was determined by clarifying goals of care, following treatment preferences, providing personalized care, and the patient's environment.Conclusions: Hospice patients usually transfer to facilities to accomplish goals consistent with good end-of-life care. We can improve their experience by treating patients and their caregivers as unique individuals, exploring and respecting treatment preferences, and creating a pleasant physical environment.