A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers.
A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers.
复制标题
DOI：
10.1186/1471-2296-14-133
复制
发表时间：
2013-09-08
影响因子：
2.9
通讯作者：
Wodchis WP
中科院分区：
文献类型：
--
作者：
Kuluski K;Gill A;Naganathan G;Upshur R;Jaakkimainen RL;Wodchis WP
目标设定是临床护理中推荐的方法，可以帮助患有多种疾病的个人及其护理人员管理慢性疾病。本文从患者、照顾者和医生的角度探讨了对患有多种疾病的老年人重要的目标类型。对每个患者、护理人员和医生的目标进行比较，以确定一致性。这项研究是一个定性的描述性研究，通过半结构化的一对一的访谈。该研究于2012年5月至10月在加拿大安大略的家庭健康团队进行。样本包括28名家庭医学患者，他们的非正式照顾者和家庭医生。社会人口学数据通过SPSS Version 17中的描述性统计进行分析。使用NVivo 9按主题分析了与患者护理目标相关的开放式问题。每个参与者组（患者，护理人员和家庭医生）的患者护理目标的主题。在此之后，检查了每个三合会的目标一致性。目标一致性被定义为在特定三元组中所有三方对至少一个目标的一致性（即，患者、护理人员和家庭医生）。超过一半的患者是男性（56%）;他们的平均年龄为82.3岁，健康状况为4.61。大多数照顾者是女性（82%）; 61%是被照顾者的配偶。在总体水平上，患者、护理人员和家庭医生表达的共同目标是维持患者的功能独立性和管理其症状或功能挑战。尽管这些共同的目标，在总体水平上，很少对齐的目标时，发现跨病人照顾者和医生三合会。当患者的功能或认知健康状况不稳定或下降时;当注意到安全威胁时;以及当需要加强护理服务时，往往会发生缺乏一致性。数据表明，当患者病情不太稳定时，往往会发生目标分歧。虽然由于每个参与者的角色和责任不同，可能会出现目标分歧，但在制定护理计划时，应阐明这些观点。需要进一步研究，以观察在家庭实践中目标设定的程度，以及如何将其作为实践标准。
Goal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment. The study was a qualitative descriptive study facilitated through semi-structured one-on-one interviews. The study took place between May and October 2012 at a Family Health Team located in Ontario, Canada. The sample included 28 family medicine patients, their informal caregivers and family physicians. Socio-demographic data were analyzed via descriptive statistics in SPSS Version 17. Open ended questions pertaining to patient goals of care were analyzed thematically using NVivo9. Themes were derived on patient care goals for each of the participant groups (patients, caregivers and family physicians). Following this, alignment of goals across each of the triads was examined. Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad (i.e., patient, caregiver and family physician). Just over half of the patients were male (56%); they had an average age of 82.3 years and 4.61 health conditions. Most of the caregivers were female (82%); and 61% were a spouse of the care recipient. At the aggregate level, common goals expressed among patients, caregivers and family physicians were the maintenance of functional independence of patients and the management of their symptoms or functional challenges. Despite these common goals at the aggregate level, little alignment of goals was found when looking across patient-caregiver and physician triads. Lack of alignment tended to occur when patients had unstable or declining functional or cognitive health; when safety threats were noted; and when enhanced care services were required. The data suggest that goal divergence tends to occur when patients are less medically stable. While goal divergence may be expected due to the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans. Further research is required to observe the extent to which goal setting occurs in family practice as well as how it can be embedded as a standard of practice.
登录
查看更多内容
影响因子：
120.7
作者：
Boyd, CM;Darer, J;Wu, AW
通讯作者：
Wu, AW
影响因子：
9.7
作者：
Schoen, Cathy;Osborn, Robin;Peugh, Jordon
通讯作者：
Peugh, Jordon
影响因子：
4.4
作者：
Fortin, M;Bravo, G;Lapointe, L
通讯作者：
Lapointe, L
影响因子：
6.7
作者：
Parsons, John;Rouse, Paul;Connolly, Martin J.
通讯作者：
Connolly, Martin J.
影响因子：
5.9
作者：
Bogardus, ST;Bradley, EH;Inouye, SK
通讯作者：
Inouye, SK