Content Analysis of Negative Online Reviews of Hospice Agencies in the United States.
Content Analysis of Negative Online Reviews of Hospice Agencies in the United States.
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DOI：
10.1001/jamanetworkopen.2019.21130
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发表时间：
2020-02-05
影响因子：
13.8
通讯作者：
Tate CE
中科院分区：
文献类型：
--
作者：
Brereton EJ;Matlock DD;Fitzgerald M;Venechuk G;Knoepke C;Allen LA;Tate CE
随着医疗保健在线评论越来越成为患者决策的一部分，了解其内容可以帮助医疗保健实践识别和解决患者的问题。找出美国各地安宁疗护机构网上负面（即一星）评论中最常被引用的投诉。本定性研究对2011年8月至2019年7月期间发布的美国临终关怀机构在线评论进行了专题分析。样本选自Hospice Analytics数据库。在每个州，从数据库中的超大型临终关怀机构（即每天服务200名病人）类别中随机抽取1家营利性临终关怀机构（n = 50）和1家非营利性临终关怀机构（n = 50）。数据分析时间为2019年1月至2019年4月。对评审进行分析，以确定评审人员所表达的最普遍的关注点。在研究样本中的100家临终关怀机构中，67家（67.0%）获得了1星评价；33家（49.3%）为营利性设施，34家（50.7%）为非营利性设施。在137个独立评论中，68个（49.6%）是针对营利性设施的，69个（50.4%）是针对非营利设施的。在编码和分析过程中，共出现了5个主题，分别是：期望不一致、沟通不理想、护理质量、对临终关怀角色的误解以及善死的意义。前三个主题被归类为可操作的批评，这是临终关怀组织可以改变的变量。其余两个主题被归类为无法采取行动的批评，这些因素需要更大的系统变革来解决。对于营利性和非营利性的临终关怀机构来说，护理质量是最常被评论的主题（212条评论中有117条[55.2%]）。营利性临终关怀机构总体上收到了更多与沟通相关的评论（130人中有34人[26.2%]对82人中有9人[11.0%]），而非营利性临终关怀机构收到了更多关于临终关怀角色（33人中有23人[69.7%]对31人中有19人[61.3%]）和死亡质量（16人[48.5%]对12人[38.7%]）的评论。关于可采取行动的批评，临终关怀机构可以检查他们目前的做法，考虑到评论者将这些问题描述为对失去亲人的艰难经历产生负面影响。研究结果显示，对于安宁疗护人员、安宁疗护服务和临终过程，病人及其家人、朋友和照护者需要深入的指导和指导。在安宁疗护登记期间，本研究中发现的一些批评，可以透过对这些主题进行可操作的、明确的对话来减轻。
As online reviews of health care become increasingly integral to patient decision-making, understanding their content can help health care practices identify and address patient concerns. To identify the most frequently cited complaints in negative (ie, 1-star) online reviews of hospice agencies across the United States. This qualitative study conducted a thematic analysis of online reviews of US hospice agencies posted between August 2011 and July 2019. The sample was selected from a Hospice Analytics database. For each state, 1 for-profit (n = 50) and 1 nonprofit (n = 50) hospice agency were randomly selected from the category of extra-large hospice agencies (ie, serving >200 patients/d) in the database. Data analysis was conducted from January 2019 to April 2019. Reviews were analyzed to identify the most prevalent concerns expressed by reviewers. Of 100 hospice agencies in the study sample, 67 (67.0%) had 1-star reviews; 33 (49.3%) were for-profit facilities and 34 (50.7%) were nonprofit facilities. Of 137 unique reviews, 68 (49.6%) were for for-profit facilities and 69 (50.4%) were for nonprofit facilities. A total of 5 themes emerged during the coding and analytic process, as follows: discordant expectations, suboptimal communication, quality of care, misperceptions about the role of hospice, and the meaning of a good death. The first 3 themes were categorized as actionable criticisms, which are variables hospice organizations could change. The remaining 2 themes were categorized as unactionable criticisms, which are factors that would require larger systematic changes to address. For both for-profit and nonprofit hospice agencies, quality of care was the most frequently commented-on theme (117 of 212 comments [55.2%]). For-profit hospice agencies received more communication-related comments overall (34 of 130 [26.2%] vs 9 of 82 [11.0%]), while nonprofit hospice agencies received more comments about the role of hospice (23 of 33 [69.7%] vs 19 of 31 [61.3%]) and the quality of death (16 [48.5%] vs 12 [38.7%]). Regarding actionable criticisms, hospice agencies could examine their current practices, given that reviewers described these issues as negatively affecting the already difficult experience of losing a loved one. The findings indicated that patients and their families, friends, and caregivers require in-depth instruction and guidance on what they can expect from hospice staff, hospice services, and the dying process. Several criticisms identified in this study may be mitigated through operationalized, explicit conversations about these topics during hospice enrollment.
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