Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives
Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives
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DOI：
10.1089/jpm.2015.0178
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发表时间：
2016-01-01
影响因子：
2.8
通讯作者：
Adelman, Ronald D.
中科院分区：
文献类型：
--
作者：
Phongtankuel, Veerawat;Scherban, Benjamin A.;Adelman, Ronald D.
背景资料：临终关怀为患者提供了在生命结束时在家接受护理的机会;然而，大约25%从临终关怀中退出的患者住院治疗。住院可能导致护理过渡不良，并导致不必要的护理和不良患者结局。在这一患者人群中检查住院原因的研究有限。目的：本研究旨在透过安宁疗护跨学科团队成员的观点，了解居家安宁疗护病患住院的原因。方法：这是一个定性研究，采用扎根理论的方法。七个半结构式焦点小组进行征求的原因，在家庭安宁病人住院。参与者包括来自纽约市一家非营利临终关怀机构的73名家庭临终关怀IDT成员。焦点小组录音转录和分析使用内容分析。结果如下：确定了八大主题：（1）不完全理解临终关怀，（2）缺乏对疾病预后的明确性，（3）希望继续接受非临终关怀医生和医院的护理，（4）护理人员负担，（5）令人痛苦/难以管理的体征和症状，（6）护理人员不愿意给予吗啡，（7）与临终关怀相比，911的响应时间更快，（8）家属难以接受患者死亡。结论：居家安宁疗护病人住院的原因是多方面的，复杂的。我们的研究强调了患者、家人、医生和临终关怀机构在家庭临终关怀和住院治疗方面面临的障碍和挑战。需要进行更多的研究来阐明这些问题，并制定可行的战略来解决这些问题。
Background: Hospice provides an opportunity for patients to receive care at home at the end of life (EOL); however, approximately 25% of patients who disenroll from hospice are hospitalized. Hospitalization can lead to poor care transitions and result in unwarranted care and adverse patient outcomes. Research examining reasons for hospitalization in this patient population is limited. Objective: The objective was to understand the reasons for hospitalization among home hospice patients through the perspectives of hospice interdisciplinary team (IDT) members. Methods: This was a qualitative study using a grounded theory approach. Seven semistructured focus group were conducted to solicit reasons for hospitalization among home hospice patients. Participants consisted of 73 home hospice IDT members from a not-for-profit hospice agency in New York City. Focus group recordings were transcribed and analyzed using content analysis. Results: Eight major themes were identified: (1) not fully understanding hospice, (2) lack of clarity about disease prognosis, (3) desire to continue receiving care from nonhospice physicians and hospital, (4) caregiver burden, (5) distressing/difficult-to-manage signs and symptoms, (6) caregivers' reluctance to administer morphine, (7) 911's faster response time compared to hospice, and (8) families' difficulty accepting patients' mortality. Conclusions: Reasons for hospitalization in home hospice patients are multifactorial and complex. Our study highlights barriers and challenges that patients, families, physicians, and hospices face around home hospice care and hospitalization. More research is needed to elucidate these issues and develop viable strategies to address them.