Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-11-08 DOI:10.1016/j.amjsurg.2024.116063

Emily E. Evans , Sarah E. Bradley , C. Ann Vitous , Cara Ferguson , R. Evey Aslanian , Shukri H.A. Dualeh , Christina L. Shabet , M. Andrew Millis , Pasithorn A. Suwanabol

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引用次数: 0

Abstract

Background

Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.

Methods

Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.

Results

Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers.

Conclusions

While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.

查看原文本刊更多论文

退伍军人健康管理局医院围手术期姑息治疗的障碍：定性评估。

背景：尽管姑息关怀对患局限性疾病或临近生命末期的患者有明显的益处，但对外科手术患者的使用仍普遍不足：尽管姑息治疗对患局限性疾病或临近生命末期的病人有明显的益处，但外科病人对姑息治疗的使用仍然普遍不足：对 14 家预先指定的退伍军人事务（VA）医院的医护人员进行了访谈，探讨了重症手术患者的临终关怀。结果：确定了六个主要领域：结果：确定了六个主要领域。在患者和家属层面，障碍包括管理期望值和目标不一致的护理。在医护人员层面，对姑息关怀的认识和态度以及医护人员的角色和身份是经常提到的障碍。在系统层面，参与者认为机构资源和文化是重大障碍：尽管医疗服务提供者认识到姑息关怀和临终关怀的重要性，但在不同层面上都存在使用姑息关怀的障碍。对这些障碍的识别突出了未来工作的重点领域，以提高退伍军人姑息关怀和临终关怀的质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.