End of Life Care in Assisted Living Facilities

描述(由申请人提供)：这项研究的目的是解决在发展最快、但研究不足的、针对虚弱老年人的居住环境--辅助生活设施(ALF)--的临终关怀(EOL)方面缺乏描述性知识。在全国范围内，据估计，死亡占ALF居民年营业额的28%。越来越多的濒临死亡的ALF居民参加临终关怀计划。尽管预测ALF的入住率将在几年内超过疗养院，并估计到2020年，目前全国100万ALF居民的人口将翻一番，但关于ALF的EOL护理和临终关怀参与的信息有限。具体地说，这项研究将考察ALF工作人员和临终关怀护士的观点：1)如何为ALF住院患者提供EOL护理；2)ALF中EOL护理的促进者和障碍。它涉及国家卫生研究院的倡议“临终关怀研究”(RFA-NR-99-004，1/20/99)，以及医学研究所呼吁研究如何以及在哪里死亡的临终关怀。将采用定性描述性设计。面对面的半结构化访谈将在俄勒冈州的农村和城市进行，有目的的抽样多达36名ALF和临终关怀护士。此外，还将分析ALF中用于EOL关怀的文件(例如，流程图、协议)。定性内容分析将包括以下部分：文本数据的开放编码、文本数据和文件的持续比较分析、负面案例分析、理论备忘录和文件踪迹。将确定关怀活动的主要特点、活动开展方式的异同以及相关的挑战和障碍。这项研究的最终结果将是从提供或监督这种护理的工作人员的角度，详细描述ALF住院医生如何进行EOL护理。这些发现与PIs早先对垂死居民及其家人的发现相结合，将成为在随后的R01研究中开发和测试旨在改善ALF EOL护理的模型干预的基础。

DESCRIPTION (provided by applicant): The purpose of this study is to address the absence of descriptive knowledge about end-of-life (EOL) care in the fastest growing, yet understudied, congregate residential setting for frail older adults, assisted living facilities (ALF). Nationally it is estimated that death accounts for 28% of the annual turnover in ALF residents. Increasingly, dying ALF residents are enrolled in hospice programs. Despite projections that ALFs will surpass nursing homes in occupancy within several years, and estimates that the current national population of 1 million ALF residents will double by 2020, there is limited information on EOL care and hospice involvement in ALFs. Specifically, this study will examine the perspectives of ALF staff and hospice nurses on: 1) how EOL care is provided for ALF residents and 2) facilitators and barriers to EOL care in ALFs. It addresses the National Institutes of Health initiative "Research on Care at the End-of-Life" (RFA-NR-99-004, 1/20/99) and the Institute of Medicine's call for research on EOL care that informs both how and where people die. A qualitative descriptive design will be used. Face-to-face semi-structured interviews will be conducted with a purposeful sampling of up to 36 ALF and hospice nurses in both rural and urban sites in Oregon. In addition, documents used in EOL care in ALFs will also be analyzed (e.g., flow sheets, protocols). Qualitative content analysis will include the following components: open coding of text data, constant comparative analysis of text data and documents, negative case analysis, theoretical memos, and document trails. Key characteristics of the care activities, similarities and differences in how the activities are performed, and related challenges and barriers will be identified. The end product of this study will be a detailed description of how EOL care happens for ALF residents, from the perspectives of the staffs that provide or supervise this care. The findings in combination with the PIs earlier findings from dying residents and their families will be the basis for developing and testing a model intervention aimed at improving EOL care in ALFs in a subsequent R01 study.