Making sure services deliver for people with advanced heart failure: a longitudinal qualitative study of patients, family carers, and health professionals
Making sure services deliver for people with advanced heart failure: a longitudinal qualitative study of patients, family carers, and health professionals
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DOI：
10.1177/0269216309346541
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发表时间：
2009-12-01
影响因子：
4.4
通讯作者：
Murray, Scott A.
中科院分区：
文献类型：
--
作者：
Boyd, Kirsty J.;Worth, Allison;Murray, Scott A.
本研究的目的是从多个角度评估晚期心力衰竭患者服务的关键组成部分，并建议如何根据英国长期条件，姑息治疗和临终关怀政策提供护理。连续采访进行了2年以上的患者，病例相关的家庭照顾者和专业人士（n = 162），其次是四个焦点小组，涉及患者，照顾者和关键的专业人士（n = 32）。有36名晚期心力衰竭患者，30名家庭护理人员和62名专业人员参与了这项研究，他们来自英国一个健康地区，具有各种心力衰竭护理模式。与会者确认了一个关键的卫生专业人员协调护理，整体评估和定期监测的价值。缺乏时间和资源，由于竞争的优先事项，在初级保健，未能响应心力衰竭疾病轨迹的波动，从专科护士直接护理或更多的咨询作用之间的平衡的关注和难以判断何时转向姑息治疗阻碍了一致的主动护理。制定了心力衰竭护理框架，包括关键阶段和服务响应。我们的结论是，需要姑息治疗的长期条件的患者应确定和管理使用务实的标准，包括积极转变护理目标。
The objective of this study was to evaluate the key components of services for people with advanced heart failure from multiple perspectives and recommend how care might be delivered in line with UK policies on long-term conditions, palliative and end-of-life care. Serial interviews were conducted over 2 years with patients, case-linked family carers and professionals (n = 162); followed by four focus groups involving patients, carers and key professionals (n = 32). There were 36 patients with advanced heart failure, 30 family carers and 62 professionals included in the study from a UK health region with various heart failure care models. Participants confirmed the value of a key health professional coordinating care, holistic assessment and regular monitoring. A lack of time and resources due to competing priorities in primary care, failure to respond to the fluctuations of a heart failure illness trajectory, concerns about the balance between direct care from specialist nurses or a more advisory role and difficulty in judging when to move towards palliative care hindered consistent access to proactive care. A heart failure care framework, with key stages and service responses, was developed. We conclude that patients with long-term conditions needing palliative care should be identified and managed using pragmatic criteria that include a proactive shift in care goals.