PDF(Pubmed)
Abstract：
BACKGROUND: Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients\' values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH.
METHODS: We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: \"SICG interpretation\" and \"SICG feedback\". For providers, we used domains from the Toolkit of Adaptation Approaches: \"collaborative working\", \"team\", \"endorsement\", \"materials\", \"messages\", and \"delivery\". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement.
RESULTS: The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses\' and social workers\' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations.
CONCLUSIONS: The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.
METHODS: We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: \"SICG interpretation\" and \"SICG feedback\". For providers, we used domains from the Toolkit of Adaptation Approaches: \"collaborative working\", \"team\", \"endorsement\", \"materials\", \"messages\", and \"delivery\". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement.
RESULTS: The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses\' and social workers\' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations.
CONCLUSIONS: The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.
摘要：
背景：经历无家可归（OAEH）的老年人比他们的同居者更快衰老和死亡。疾病相关的决定最好以患者价值观为指导，但是医疗保健和无家可归服务提供商需要支持来促进这些讨论。《严重疾病对话指南》（SICG）是指导讨论的交流工具，但尚未适用于OAEH。
方法：我们的目标是使SICG适应护士使用OAEH，社会工作者,和其他无家可归的服务提供商。我们使用SICG对无家可归者服务提供商进行了半结构化访谈，并对OAEH进行了认知访谈。服务提供者包括护士，社会工作者,或其他在无家可归的环境中工作的人。OAEH至少50岁，被诊断患有严重疾病。在收容所进行了采访并录制了音频，过渡性住房,医院,公共空间,和过度缩放。研究小组审查了成绩单，识别跨成绩单的共同主题，并应用分析笔记。我们总结了每个参与者组的成绩单，应用快速定性分析。对于OAEH来说,引用有关SICG工具的建议改编或反馈的数据分为两个域：“SICG解释”和“SICG反馈”。对于提供者，我们使用了适应方法工具包中的域：“协作工作”，\"团队\",\"背书\",\"材料\",\"messages\",和“交货”。摘要被分组为矩阵，以帮助可视化主题以告知适应。然后，专家姑息治疗临床医生对改编后的指南进行了审查，以进一步完善。
结果：最终样本包括11个OAEH（45％黑色，61±7岁)和10名提供者(80%白人，8.9±年实践)。适应主题包括更改单词和短语，以（1）增加对话目的的透明度，(2)促进OAEH自治和赋权，（3）符合护士和社会工作者关于促进诊断和预后意识的实践范围，(4)对零散医疗保健的现实敏感。答复还显示了培训和实施方面的考虑。
结论：适应的SICG是一种有希望的临床工具，可以帮助与OAEH进行严重疾病对话。未来的研究应使用此更新的实施计划指南。额外的调整可能取决于SICG将被递送的特定设置。
方法：我们的目标是使SICG适应护士使用OAEH，社会工作者,和其他无家可归的服务提供商。我们使用SICG对无家可归者服务提供商进行了半结构化访谈，并对OAEH进行了认知访谈。服务提供者包括护士，社会工作者,或其他在无家可归的环境中工作的人。OAEH至少50岁，被诊断患有严重疾病。在收容所进行了采访并录制了音频，过渡性住房,医院,公共空间,和过度缩放。研究小组审查了成绩单，识别跨成绩单的共同主题，并应用分析笔记。我们总结了每个参与者组的成绩单，应用快速定性分析。对于OAEH来说,引用有关SICG工具的建议改编或反馈的数据分为两个域：“SICG解释”和“SICG反馈”。对于提供者，我们使用了适应方法工具包中的域：“协作工作”，\"团队\",\"背书\",\"材料\",\"messages\",和“交货”。摘要被分组为矩阵，以帮助可视化主题以告知适应。然后，专家姑息治疗临床医生对改编后的指南进行了审查，以进一步完善。
结果：最终样本包括11个OAEH（45％黑色，61±7岁)和10名提供者(80%白人，8.9±年实践)。适应主题包括更改单词和短语，以（1）增加对话目的的透明度，(2)促进OAEH自治和赋权，（3）符合护士和社会工作者关于促进诊断和预后意识的实践范围，(4)对零散医疗保健的现实敏感。答复还显示了培训和实施方面的考虑。
结论：适应的SICG是一种有希望的临床工具，可以帮助与OAEH进行严重疾病对话。未来的研究应使用此更新的实施计划指南。额外的调整可能取决于SICG将被递送的特定设置。
