Clinicians' Perceptions of Collaborative Palliative Care Delivery in Chronic Kidney Disease.
Clinicians' Perceptions of Collaborative Palliative Care Delivery in Chronic Kidney Disease.
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DOI：
10.1016/j.jpainsymman.2022.04.167
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发表时间：
2022-08
影响因子：
4.7
通讯作者：
Kavalieratos, Dio
中科院分区：
文献类型：
--
作者：
Ernecoff, Natalie C.;Bell, Lindsay F.;Arnold, Robert M.;Shea, Christopher M.;Switzer, Galen E.;Jhamb, Manisha;Schell, Jane O.;Kavalieratos, Dio
指南建议慢性肾脏疾病(CKD)患者接受姑息治疗，这些患者经历了很高的疼痛和症状负担，并接受了往往与他们的价值观不一致的强化治疗。缺乏可扩展的专业姑息治疗服务，促使人们呼吁关注初级姑息治疗，这些服务在初级保健和肾脏病环境中提供。这项研究的目的是(1)描述对护理的期望，以满足CKD患者的姑息护理需求，以及在当前模型中满足这些期望的局限性，以及(2)确定满足患者姑息护理需求的潜在干预措施。我们对初级保健、肾脏病和姑息治疗的临床医生进行了半结构化访谈，以评估(1)满足姑息治疗需求的合理期望，(2)整合初级姑息治疗的障碍，以及(3)潜在的干预点。临床医生讨论了他们对高质量沟通的期望(例如，讨论疾病理解、评估护理目标)以及更好地整合姑息治疗服务。临床医生表示，提供这种护理存在障碍，包括临床医生之间沟通不畅。为了解决障碍，临床医生概述了潜在的干预点，例如建立协作护理模式，以及确定哪些患者可能适合姑息治疗的结构性触发因素。为解决慢性肾脏病患者在姑息治疗方面的差距而采取的干预措施应包括系统地识别有姑息治疗需求的患者，以及通过专科和初级姑息治疗来满足这些需求的结构性机制。
Guidelines recommend palliative care for patients with chronic kidney disease (CKD), who experience a high pain and symptom burden, and receive intensive treatments that often do not align with their values. A lack of scalable specialty palliative care services has prompted calls for attention to primary palliative care, delivered in primary care and nephrology settings. The objectives of this study were to (1) describe expectations for care to meet the palliative care needs of people living with CKD, and limitations to meeting those expectations in the current model, and (2) identify potential interventions to meet patients’ palliative care needs. We conducted semi-structured interviews with clinicians from primary care, nephrology, and palliative care to assess (1) reasonable expectations for meeting palliative needs, (2) barriers to integrating primary palliative care, and (3) potential intervention points. Clinicians discussed their expectations for high-quality communication (e.g., discussing disease understanding, assessing goals of care) and better integration of palliative care services. Clinicians expressed barriers to delivering that care, including poor inter-clinician communication. To address barriers, clinicians outlined potential intervention points, such as building collaborative models of care, and structural triggers to identify patients who may be appropriate for palliative care. Interventions to address gaps in palliative care delivery for people living with CKD should incorporate systematic identification of patients with palliative care needs and structural mechanisms to meeting those needs via specialty and primary palliative care.
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影响因子：
5.4
作者：
Kavalieratos D;Mitchell EM;Carey TS;Dev S;Biddle AK;Reeve BB;Abernethy AP;Weinberger M
通讯作者：
Weinberger M
影响因子：
2.8
作者：
Scibetta, Colin;Kerr, Kathleen;Rabow, Michael W.
通讯作者：
Rabow, Michael W.
DOI：
10.2215/cjn.11351015
发表时间：
2016-05-06
影响因子：
9.8
作者：
O'Hare, Ann M.;Szarka, Jackie;Vig, Elizabeth K.
通讯作者：
Vig, Elizabeth K.
DOI：
10.2215/cjn.11770720
发表时间：
2021-06-01
影响因子：
9.8
作者：
Cohen, Robert A.;Bursic, Alexandra;Schell, Jane O.
通讯作者：
Schell, Jane O.
影响因子：
4.7
作者：
Schockett, ER;Teno, JM;Stuart, B
通讯作者：
Stuart, B