Palliative Care in the Acute Care Setting

描述(由申请人提供)：姑息治疗(PC)咨询干预服务在急诊医院环境中急剧增加，但对干预所需的所有知识知之甚少。这项为期4年的人种学研究的总体目的是在急性护理医院文化的背景下，对姑息关怀咨询服务所涉及的多个方面、它们如何工作、它们的障碍和促进者以及它们的具体结果进行深入的描述。 有强有力的证据表明，护理提供者在急性护理环境中没有适当地管理疼痛和其他症状，如呼吸困难和疲劳，特别是对生命即将结束的患者。在与患有严重和/或危及生命的疾病的住院患者进行沟通、治疗决策以及在必要时进行生命终结计划方面存在困难。需要定期住院的成年人寿命更长、患有严重慢性病的人数正在迅速增加。为了认识到这些和其他问题，医院正在开发多学科姑息治疗计划。然而，将PC整合到急性护理环境中是具有挑战性的，因为姑息治疗和急性护理专业来自两种不同的文化，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集，以及在医院环境中与PC会诊相关的促进者和障碍；2)描述在顺序和同时PC会诊中积极和姑息治疗目标的模式及其随时间的变化；3)从患者、家庭、转诊和PC咨询提供者的角度考察PC咨询的经验和文化；以及4)从患者、家庭、转诊和PC咨询提供者的角度描述PC咨询的结果。这项及时的研究将通过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，从而帮助填补科学知识的关键空白，进而允许开发有效的干预措施，以改善急性护理环境中的PC。

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.