Expert views on the factors enabling good end of life care for people with dementia: a qualitative study.
Expert views on the factors enabling good end of life care for people with dementia: a qualitative study.
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DOI：
10.1186/s12904-015-0028-9
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发表时间：
2015-07-25
影响因子：
3.1
通讯作者：
Robinson L
中科院分区：
文献类型：
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作者：
Lee RP;Bamford C;Exley C;Robinson L
在所有长期疾病中，痴呆症是最大的慢性病负担，预计到2040年，患有痴呆症等与年龄相关疾病的人数将翻一番。晚期痴呆症患者的症状与癌症死亡患者相似，但专业护理人员发现预测困难，难以满足姑息治疗需求，身体症状未被发现和治疗。虽然在理论上已经确定了这一领域的良好做法的要素，但需要更好地了解使这种良好做法能够在现实世界的实践中得到实施的因素。这项研究的目的是确定专家对影响痴呆症患者临终关怀良好做法的关键因素的看法。半结构化电话和面对面访谈，主题指导，逐字抄写和主题分析。采访了英国痴呆症护理和/或姑息治疗方面的专家(n = 30)。通过专家访谈确定了影响痴呆患者临终关怀良好做法的四个关键因素：护理的领导和管理、临床专业知识的整合、护理的连续性和指南的使用。这四个关键因素之间的关系很重要。护理的领导和管理对指导方针的成功实施具有影响，而适当和及时地使用临床专业知识可以防止住院和确保护理的连续性。在保健和社会保健方面缺乏一体化可能会破坏保健的连续性。还需要进一步的工作，以了解现有的准则和工具如何有助于良好做法。本文介绍了由国家卫生研究所在其应用研究计划补助金(补助金编号为RP-PG-0611-20005)下资助的独立研究。所表达的观点仅代表提交人(S)的观点，不一定代表国民健康保险制度、国民健康保险制度或卫生部的观点。
Dementia, of all long term illnesses, accounts for the greatest chronic disease burden, and the number of people with age-related diseases like dementia is predicted to double by 2040. People with advanced dementia experience similar symptoms to those dying with cancer yet professional carers find prognostication difficult and struggle to meet palliative care needs, with physical symptoms undetected and untreated. While elements of good practice in this area have been identified in theory, the factors which enable such good practice to be implemented in real world practice need to be better understood. The aim of this study was to determine expert views on the key factors influencing good practice in end of life care for people with dementia. Semi-structured telephone and face-to-face interviews with topic guide, verbatim transcription and thematic analysis. Interviews were conducted with experts in dementia care and/or palliative care in England (n = 30). Four key factors influencing good practice in end of life care for people with dementia were identified from the expert interviews: leadership and management of care, integrating clinical expertise, continuity of care, and use of guidelines. The relationships between the four key factors are important. Leadership and management of care have implications for the successful implementation of guidelines, while the appropriate and timely use of clinical expertise could prevent hospitalisation and ensure continuity of care. A lack of integration across health and social care can undermine continuity of care. Further work is needed to understand how existing guidelines and tools contribute to good practice. This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0611-20005). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.