"你是谁,你住在哪里很重要":COVID-19 期间纽约市的安宁疗护对安宁疗护和社会决定因素的看法:快速定性分析。

IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Journal of palliative medicine Pub Date : 2024-10-25 DOI:10.1089/jpm.2024.0124
Daniel David, Laura T Moreines, Jonelle Boafo, Patricia Kim, Emily Franzosa, Dena Schulman-Green, Abraham A Brody, Melissa D Aldridge
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引用次数: 0

摘要

背景:健康的社会决定因素 (SDOH) 影响了在 COVID-19 大流行期间提供的居家安宁疗护的质量。提供安宁疗护的专业人士从他们的视角指出了所面临的挑战以及从中吸取的经验教训。目标:研究安宁疗护专业人员对 SDOH 如何影响 COVID-19 大流行期间在纽约市(NYC)提供高质量居家安宁疗护的看法。方法:我们采用定性描述设计,对在纽约市 COVID-19 大流行期间为居家安宁疗护患者提供护理服务的 30 名安宁疗护专业人员进行了半结构化访谈。我们采用了有目的的抽样方法来招募来自不同学科的专业人员,包括医生、高级医疗服务提供者、护士、社会工作者、牧师以及安宁疗护行政和管理人员。参与者供职于纽约市两家大型安宁疗护机构中的一家,以及为纽约市五个区和周边郊区提供服务的一家姑息关怀门诊机构。采用快速定性分析来确定主题。结果:30 位安宁疗护专业人士接受了访谈,他们的临床和行政职务各不相同。大多数人(30 人中有 21 人)表示,社会决定因素影响了公平安宁疗护的获得和/或提供。访谈中出现了两个关键主题:(1) SDOH 的存在影响了高质量护理的提供;(2) COVID-19 大流行期间,差异加剧,造成了护理障碍。次主题概述了安宁疗护专业人员所描述的障碍:安宁疗护注册人数减少、远程医疗面临挑战,导致病人/家属教育不足、一些社区护理助理短缺,以及一些病人的安宁疗护整体质量下降。通过邻里因素、资源障碍和系统挑战,SDOH对安宁疗护造成了障碍。结论:SDOH 为了解安宁疗护服务中的差异提供了背景。COVID-19 加剧了这些状况。解决SDOH造成的多维障碍是创造高质量、公平的安宁疗护的关键,尤其是在危机期间。
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"Who You Are and Where You Live Matters": Hospice Care in New York City During COVID-19 Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis.

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

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来源期刊
Journal of palliative medicine
Journal of palliative medicine 医学-卫生保健
CiteScore
3.90
自引率
10.70%
发文量
345
审稿时长
2 months
期刊介绍: Journal of Palliative Medicine is the premier peer-reviewed journal covering medical, psychosocial, policy, and legal issues in end-of-life care and relief of suffering for patients with intractable pain. The Journal presents essential information for professionals in hospice/palliative medicine, focusing on improving quality of life for patients and their families, and the latest developments in drug and non-drug treatments. The companion biweekly eNewsletter, Briefings in Palliative Medicine, delivers the latest breaking news and information to keep clinicians and health care providers continuously updated.
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