Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians.
Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians.
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DOI：
10.1016/j.jpainsymman.2022.05.011
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发表时间：
2022-09
影响因子：
4.7
通讯作者：
Daubman, Bethany-Rose
中科院分区：
文献类型：
--
作者：
Soltoff, Alexander;Purvis, Sara;Ravicz, Miranda;Isaacson, Mary J.;Duran, Tinka;Johnson, Gina;Sargent, Michele;LaPlante, J. R.;Petereit, Daniel;Armstrong, Katrina;Daubman, Bethany-Rose
尽管已知的文化定制的姑息治疗（PC）的重要性，美国印第安人（AI）在大平原缺乏获得此类服务。虽然在大平原照顾AI的临床医生长期以来一直承认严重疾病护理的主要障碍，但很少有文献描述影响居住在保留地的AI患者的PC访问和交付的具体因素。本研究旨在探讨影响大平原保留地PC访问和交付的因素，为AI提供文化定制的PC服务。三位作者记录并转录了与21名专科医生和17名初级临床医生的访谈。一个由7名作者组成的数据分析团队使用传统的内容分析法分析了成绩单。分析团队通过Zoom进行代码协商，对代码进行分类，并开发主题。访谈数据的定性分析揭示了四个主题，包括影响大平原美洲印第安人姑息治疗提供和获得的因素：医疗保健系统运营（例如，临终关怀和家庭健康的可用性，分散的服务），地理（例如，天气、旅行距离），劳动力要素（例如，护理连续性、工作人员不足、文化熟悉度）以及历史创伤和种族主义。我们的研究结果强调了解决重病患者旅行时间和费用的重要性，增加了家庭健康和临终关怀的可用性，并提高了对医疗系统的信任。加强人工智能医疗队伍，增加对印度卫生服务的资助，并将保留医疗保健的治理过渡到部落实体，可能会提高医疗系统的可信度。
Despite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land. This study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs. Three authors recorded and transcribed interviews with 21 specialty and 17 primary clinicians. A data analysis team of 7 authors analyzed transcripts using conventional content analysis. The analysis team met over Zoom to engage in code negotiation, classify codes, and develop themes. Qualitative analysis of interview data revealed four themes encompassing factors influencing palliative care delivery and access for Great Plains American Indians: healthcare system operations (e.g., hospice and home health availability, fragmented services), geography (e.g., weather, travel distances), workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), and historical trauma and racism. Our findings emphasize the importance of addressing the time and cost of travel for seriously ill patients, increasing home health and hospice availability on reservations, and improving trust in the medical system. Strengthening the AI medical workforce, increasing funding for the Indian Health Service, and transitioning the governance of reservation healthcare to Tribal entities may improve the trustworthiness of the medical system.
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DOI：
10.1177/1049909118817740
发表时间：
2019-05-01
影响因子：
1.9
作者：
Britt, Heather R.;Jaka, Meghan M.;Anderson, Eric W.
通讯作者：
Anderson, Eric W.
影响因子：
28.4
作者：
Fischer, Stacy M.;Kline, Danielle M.;Fink, Regina M.
通讯作者：
Fink, Regina M.
影响因子：
2.1
作者：
Elk, Ronit;Gazaway, Shena
通讯作者：
Gazaway, Shena
影响因子：
12.7
作者：
Cosby, Arthur G.;McDoom-Echebiri, M. Maya;Hanna, Heather L.
通讯作者：
Hanna, Heather L.
影响因子：
2.7
作者：
Elk, Ronit;Emanuel, Linda;Levkoff, Sue
通讯作者：
Levkoff, Sue