Improving End-of-Life Care for Diverse Populations: Communication, Competency, and System Supports
Improving End-of-Life Care for Diverse Populations: Communication, Competency, and System Supports
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DOI：
10.1177/1049909119827933
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发表时间：
2019-06-01
影响因子：
1.9
通讯作者：
Cain, Cindy L.
中科院分区：
文献类型：
--
作者：
McCleskey, Sara G.;Cain, Cindy L.
背景：虽然在临终关怀的差距已经有了很好的记录，解释持续存在的差距不太清楚。这项研究旨在探讨人们对临终关怀的不同看法，特别是关于医疗专业人员如何更好地为所有人群提供服务的看法。目的：调查不同种族和民族的临终关怀偏好的相似性和差异。设计：这项工作包括利用深入的焦点小组讨论的定性研究。设置/参与者：六个以社区为基础的焦点小组进行了共39名参与者。两组由非裔美国人参与者组成，2组由拉丁裔参与者组成，2组由白色参与者组成。结果如下：分析产生了3个主要主题：（1）关于严重疾病的清晰，全面和文化相关的提供者-患者沟通;（2）提供者的特征和能力;（3）卫生系统的支持和障碍。虽然所有群体都有个人表示强烈倾向于直接沟通，但群体内的个人各不相同。所有团体都讨论了对护理费用高昂以及财务考虑比高质量护理更重要的关切。各群体对提供者特征和边缘化感觉的关注各不相同。非裔美国人和拉丁美洲人团体强调，他们希望将特征与提供者相匹配，非裔美国人团体讨论说，他们在保健系统中的边缘化需要高度警惕，以获得高质量的保健。结论：护理的改善将来自于承认群体内的多样性，提供者的舒适和能力，更有效的护理协调，以及招聘与他们所服务的社区有相似特征的提供者。
Background: While disparities in end-of-life care have been well-documented, explanations for the persistence of disparities are less clear. This study sought to examine diverse perceptions of end-of-life care, especially regarding how medical professionals can better serve all populations. Objective: To investigate similarities and differences in end-of-life care preferences, across racial and ethnic groups. Design: This work consists of a qualitative study utilizing in-depth focus group discussions. Setting/Participants: Six community-based focus groups were conducted with a total of 39 participants. Two groups were composed of African American participants, 2 had Latino participants, and 2 groups had white participants. Results: Analysis produced 3 major themes: (1) clear, comprehensive, and culturally relevant provider-patient communication regarding serious illness; (2) provider characteristics and competency; and (3) health system supports and barriers. Although all groups had individuals who expressed a strong preference for direct communication, individuals varied within groups. All groups discussed concerns that the costs of care are high and that financial considerations are given more importance than high-quality care. Groups diverged in their focus on provider characteristics and feelings of marginalization. African American and Latino groups emphasized a desire to match characteristics with providers, and African American groups discussed that their marginalization in the health-care system requires hypervigilance to receive high-quality care. Conclusions: Improvements in care would come from acknowledging diversity within groups, provider demonstration of comfort and competence, more effective care coordination, and recruitment of providers who share similar characteristics with the communities they serve.