Palliative Care in the Acute Care Setting

急性护理环境中的姑息治疗

• 批准号: 7070682
• 负责人: SALLY A. NORTON
• 金额: $ 34.28万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7070682
• 关键词: analgesia; behavioral /social science research tag; clinical research; dyspneas; fatigue; health care personnel performance; health care service availability; health care service evaluation; health services research tag; hospices; hospital patient care; human subject; interview; longitudinal human study; patient care personnel relations; patient care planning; patient oriented research; terminal patient care

DESCRIPTION (provided by applicant): Palliative Care (PC) consultation intervention services are increasing dramatically in the acute care hospital setting with minimal knowledge of all that this intervention entails. The overall purpose of this 4- year ethnographic study is to develop a thick description of the multiple facets that a palliative care consultation service entails, how they work, their barriers and facilitators, and their specific outcomes in the context of the acute care hospital culture. There is strong evidence that care providers inadequately manage pain and other symptoms such as dyspnea and fatigue in the acute care setting, especially for patients near the end of life. There are difficulties in communication, treatment decision-making, and, when necessary, end of life planning with hospitalized persons with serious and/or life threatening illness. The number of adults living longer and living with serious chronic illness requiring periodic hospitalization is growing rapidly. In recognition of these and other concerns, hospitals are developing multidisciplinary palliative care programs. However, the integration of PC into acute care settings is challenging because palliative and acute care specialties arise from two separate cultures, the former from a hospice culture and the latter from a curative culture. The specific aims include: 1) To describe and analyze the intersection of palliative care and hospital cultures as well as the facilitators and barriers associated with PC consultation in the hospital setting; 2) To describe the patterns of aggressive and palliative care treatment goals and how they change over time in both sequential and concurrent PC consultation; 3) To examine the experiences and culture of PC consultation from the perspectives of patients, families, the referring and PC consultation providers; and 4) To describe the outcomes of PC consultation from the perspectives of patients, families, and the referring and PC consultation care providers. This timely study will help fill a critical gap in the scientific knowledge by helping researchers and providers to better understand the evolving culture in which PC is delivered which will in turn, allow for the development of effective interventions to improve PC in the acute care setting.

描述（由申请人提供）：在急症护理医院环境中，姑息治疗 (PC) 咨询干预服务正在急剧增加，但对该干预所需的所有知识却知之甚少。这项为期 4 年的人种学研究的总体目的是对姑息治疗咨询服务所需的多个方面、其工作方式、障碍和促进因素以及在急症护理医院文化背景下的具体结果进行深入描述。 有强有力的证据表明，护理人员在急性护理环境中未能充分管理疼痛和其他症状，例如呼吸困难和疲劳，特别是对于接近生命尽头的患者。在与患有严重和/或危及生命的疾病的住院患者进行沟通、治疗决策以及必要时的临终计划方面存在困难。寿命更长且患有需要定期住院的严重慢性疾病的成年人数量正在迅速增加。认识到这些和其他问题，医院正在制定多学科姑息治疗计划。然而，将 PC 整合到急症护理环境中具有挑战性，因为姑息治疗和急症护理专业源于两种不同的文化，前者来自临终关怀文化，后者来自治疗文化。 具体目标包括： 1) 描述和分析姑息治疗与医院文化的交叉点，以及与医院环境中 PC 会诊相关的促进因素和障碍； 2) 描述积极治疗和姑息治疗目标的模式，以及它们在顺序和同时 PC 咨询中如何随时间变化； 3）从患者、家属、转诊者和PC咨询提供者的角度审视PC咨询的经验和文化； 4) 从患者、家属以及转诊和 PC 咨询护理人员的角度描述 PC 咨询的结果。这项及时的研究将帮助研究人员和提供者更好地了解提供 PC 的不断发展的文化，从而有助于填补科学知识中的一个关键空白，从而有助于制定有效的干预措施来改善急症护理环境中的 PC。