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首页> 外文期刊>The American journal of hospice and palliative care >Exploratory study on end-of-life issues: barriers to palliative care and advance directives.
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Exploratory study on end-of-life issues: barriers to palliative care and advance directives.

机译：关于生命终结问题的探索性研究：姑息治疗的障碍和预先指示。

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BACKGROUND: In the United States, as in most developed countries, death is rarely unexpected. It usually occurs in older persons with chronic progressive illnesses that often are complicated by infections or exacerbations. Many patients with terminal illnesses choose palliative care to relieve symptoms, improve the quality of their lives, and strive for a peaceful death. Professionals who serve dying patients need to recognize the importance of advance directives as part of a patient's decision to forgo curative treatment for palliative care. OBJECTIVES: SOLACE (Supporters of Life-Affirming Care at End of Life) is a coalition of interdisciplinary professionals in the northern Virginia community dedicated to improving end-of-life care. The objectives of the SOLACE survey were to identify and describe: 1) professionals' perceptions about barriers related to hospice and palliative care, 2) professionals' opinions about barriers related to dying at home, 3) professionals' perceptions about barriers relatedto advance directives, and 4) relationships between professionals and their perceived barriers to advance directives and hospice and palliative care. METHODS: From several consultations with hospice experts, a survey questionnaire was developed to solicit responses from professionals on palliative care, dying at home, and advance directives. Measures that assessed obstacles to palliative care were modified from previous studies to yield composite barrier scores. From a sample of a variety of participants at a national conference on palliative care (n = 200), 101 subjects returned questionnaires (51 percent) yielding 100 usable completed forms from attendees who demonstrated an interest in palliative care and, in some cases, a high level of personal or professional experience. Survey results were analyzed on respondents' perceptions concerning barriers related to advance directives and the delivery of palliative care. RESULTS: Of the 13 obstacle statements, results show that respondents rated the top three barriers as 1) physician reluctance to make referrals (mean = 4.23), 2) physician lack of familiarity with availability and suitability of hospice (mean = 3.93), and 3) association of hospice with death (mean = 3.93). There was a statistically significant difference in scores for respondents from hospitals and respondents from hospices on their assessment of barriers for the association of hospice with death (t = -2.09, p < .05) and the lack of information about the severity of or irreversibility of the patients illness (t = -2.78, p < .01).
机译：背景：在美国，与大多数发达国家一样，死亡很少是意外的。它通常发生在患有慢性进行性疾病的老年人中，常常并发感染或加重病情。许多绝症患者选择姑息治疗以缓解症状，改善生活质量并争取和平死亡。为垂死的患者服务的专业人员需要认识到预先指示的重要性，这是患者放弃姑息治疗的治疗决定的一部分。目标：SOLACE（生命终止支持者）是北弗吉尼亚社区致力于改善生命终止护理的跨学科专业人员联盟。 SOLACE调查的目的是识别和描述：1）专业人士对临终关怀和姑息治疗相关障碍的看法; 2）专业人士对与在家中死亡相关的障碍的看法; 3）专业人士对与预先医疗指示相关的障碍的看法; （4）专业人士与他们在接受预先指示，临终关怀和姑息治疗方面的障碍之间的关系。方法：通过与临终关怀专家的几次协商，制定了调查问卷，以征求专业人士对姑息治疗，在家中死亡和预先指示的反应。以前的研究对评估姑息治疗障碍的评估方法进行了修改，以得出综合障碍评分。从全国姑息治疗会议（n = 200）的各种参与者的样本中，有101位受试者返回了问卷（占51％），从表明对姑息治疗感兴趣的参与者中获得了100份可填写的完整表格，并且在某些情况下，高水平的个人或专业经验。分析调查结果的依据是受访者对与预先医疗指示和姑息治疗的提供有关的障碍的看法。结果：在这13项障碍陈述中，结果表明，受访者将前三项障碍定为：1）医生不愿意转诊（平均= 4.23），2）医生对临终关怀的可用性和适用性不熟悉（平均= 3.93），以及3）临终关怀与死亡的关联（平均值= 3.93）。医院的受访者和临终关怀的受访者在评估临终关怀与死亡关联的障碍方面的得分存在统计学差异（t = -2.09，p <.05），并且缺乏关于严重性或不可逆性的信息患者的疾病发生率（t = -2.78，p <.01）。

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