Abstract：
UNASSIGNED: Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this.
UNASSIGNED: To co-design and implement a scalable UK model of Needs Rounds.
UNASSIGNED: A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework.
UNASSIGNED: Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each.
UNASSIGNED: Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings).
UNASSIGNED: (1) Monthly hour-long discussions of residents\' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings.
UNASSIGNED: A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement.
UNASSIGNED: Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members.
UNASSIGNED: The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents\' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services\' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality.
UNASSIGNED: COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care.
UNASSIGNED: Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff.
UNASSIGNED: Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care.
UNASSIGNED: This study is registered as ISRCTN15863801.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
Care home residents often lack access to end-of-life care from hospice teams and so may experience distressing symptoms at end of life if care home staff cannot fully meet their needs. We examined how an approach which worked well in Australia called ‘Palliative Care Needs Rounds’ (or ‘Needs Rounds’) could be used in the United Kingdom. We interviewed 28 people (care home staff, hospice staff and other National Health Service/social care professionals in the community) about their understanding of the United Kingdom setting, what might help trigger change and what results they would want. We discussed these interviews at online workshops with 43 people, where we started to develop a theory of ‘what would work, for whom, under what circumstances’ and determine what United Kingdom Needs Rounds would look like. Six specialist palliative care services, each partnered with three to six local care homes, used Needs Rounds for a year. We collected information on care home residents, staff experiences of using Needs Rounds, relatives’ perceptions of care quality, staff views of residents’ quality of death, and on their ability to provide a palliative approach to residents. We found that Needs Rounds can provide care home staff and specialist palliative care staff the opportunity to work together during a protected time, to plan for residents’ last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while using each services’ expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication between care home staff, families, specialist palliative care staff and primary care. This improves the quality of resident care, enabling residents to be cared for and die in their preferred place, and also benefits relatives by increasing their confidence in care quality.
UNASSIGNED: To co-design and implement a scalable UK model of Needs Rounds.
UNASSIGNED: A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework.
UNASSIGNED: Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each.
UNASSIGNED: Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings).
UNASSIGNED: (1) Monthly hour-long discussions of residents\' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings.
UNASSIGNED: A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement.
UNASSIGNED: Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members.
UNASSIGNED: The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents\' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services\' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality.
UNASSIGNED: COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care.
UNASSIGNED: Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff.
UNASSIGNED: Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care.
UNASSIGNED: This study is registered as ISRCTN15863801.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
Care home residents often lack access to end-of-life care from hospice teams and so may experience distressing symptoms at end of life if care home staff cannot fully meet their needs. We examined how an approach which worked well in Australia called ‘Palliative Care Needs Rounds’ (or ‘Needs Rounds’) could be used in the United Kingdom. We interviewed 28 people (care home staff, hospice staff and other National Health Service/social care professionals in the community) about their understanding of the United Kingdom setting, what might help trigger change and what results they would want. We discussed these interviews at online workshops with 43 people, where we started to develop a theory of ‘what would work, for whom, under what circumstances’ and determine what United Kingdom Needs Rounds would look like. Six specialist palliative care services, each partnered with three to six local care homes, used Needs Rounds for a year. We collected information on care home residents, staff experiences of using Needs Rounds, relatives’ perceptions of care quality, staff views of residents’ quality of death, and on their ability to provide a palliative approach to residents. We found that Needs Rounds can provide care home staff and specialist palliative care staff the opportunity to work together during a protected time, to plan for residents’ last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while using each services’ expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication between care home staff, families, specialist palliative care staff and primary care. This improves the quality of resident care, enabling residents to be cared for and die in their preferred place, and also benefits relatives by increasing their confidence in care quality.
摘要：
■养老院居民通常无法从专业姑息治疗提供者那里获得临终关怀。姑息治疗需要查房，在澳大利亚开发和测试，是解决这个问题的一种新方法。
■共同设计和实现可扩展的英国需求循环模型。
■使用卫生服务研究实施综合促进行动框架的务实实施研究。
■在六个案例研究站点（英格兰，n=4，苏格兰，n=2）包括专科姑息治疗服务，每个护理院与三到六个护理院合作。
■第一阶段：访谈(n=28名护理院工作人员，专科姑息治疗人员，亲戚,初级保健,急性护理和专职保健医生)和四个讲习班(n=43名养老院工作人员，来自专科姑息治疗团队以及患者和公众参与和参与代表的临床医生和经理)。第2阶段：访谈（n=58护理院和姑息护理专业人员）；家庭问卷（n=13亲戚）；工作人员问卷（n=171护理院工作人员）；死亡/死亡质量问卷（n=81）；患者和公众参与和参与评估访谈（n=11）；保真度评估（n=14个需求查询记录）。
■(1)每月一小时的居民物理讨论，社会心理和精神需求，除了基于案例的学习，（2）临床工作和（3）相关/多学科小组会议。
■一种程序理论，描述了在英国需要的情况下对谁有效。次要结果侧重于卫生服务使用和成本效益，死亡和死亡的质量，养老院员工的信心和能力，以及使用患者和公众的参与和参与。
■与六个地点的主要利益相关者进行半结构化访谈和研讨会；采用姑息方法的能力，死亡质量和死亡指数，和加拿大医疗保健评估项目精简版问卷；需求汇总记录；有关居民人口统计/医疗服务使用的养老院数据；由需求汇总引发的评估和干预措施；与学术和患者以及公众参与和参与成员的半结构化访谈。
■计划理论：虽然养老院员工经历了诸如高更替等劳动力挑战，可变的技能和信心，需求查房可以为护理院和专业姑息治疗人员提供在受保护时间内进行合作的机会，计划居民生活的最后几个月。需求调查建立护理院员工的信心，并可以加强关系和信任，同时利用服务互补的专业知识。需求回合加强了对死亡的理解，症状管理,提前/预期护理计划和沟通。这可以改善住院医师的护理，使居民能够在他们喜欢的地方得到照顾和死亡，并可能通过增加亲属对护理质量的信心而受益。
■COVID-19限制干预和数据收集。由于样本量不足，无法对需求汇总进行成本效益分析,也无法计算治疗效果或家庭对护理的看法.
■我们的工作表明，需求统计可以改善养老院居民的生活和死亡质量，通过提高员工的技能和信心，包括症状管理，与全科医生和亲属的沟通，并加强疗养院和专业姑息治疗人员之间的关系。
■进行成本效益和治疗效果分析。与专员和政策制定者的互动可以检查将需求调查纳入整个英国的养老院和初级保健，以确保公平获得专科护理。
■本研究注册为ISRCTN15863801。
■该奖项由国家健康与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：NIHR128799）资助，并在健康与社会护理提供研究中全文发表。12号19.有关更多奖项信息，请参阅NIHR资助和奖励网站。
疗养院居民通常无法从临终关怀团队获得临终关怀，因此如果疗养院工作人员不能完全满足他们的需求，可能会在临终时经历痛苦的症状。我们研究了如何在英国使用在澳大利亚行之有效的称为“姑息治疗需求汇总”（或“需求汇总”）的方法。我们采访了28人(养老院工作人员，临终关怀人员和社区中的其他国家卫生服务/社会护理专业人员）关于他们对英国环境的理解，什么可能有助于触发变化，以及他们想要什么结果。我们在43人的在线研讨会上讨论了这些采访，在那里我们开始发展一种“什么会起作用”的理论，为谁,在什么情况下“并确定英国的需求回合会是什么样子。六项专科姑息治疗服务,每个都与三到六个当地护理院合作，使用了一年的需求回合。我们收集了养老院居民的信息，员工使用需求查询的经验，亲属对护理质量的看法，工作人员对居民死亡质量的看法，以及他们为居民提供姑息治疗的能力。我们发现，需要查房可以为护理院工作人员和专业姑息护理工作人员提供在受保护的时间内一起工作的机会，计划居民最后几个月的生活。需求调查建立护理院员工的信心，并可以加强关系和信任，同时使用每个服务的专业知识。需求回合加强了对死亡的理解，症状管理,提前/预期护理计划和养老院工作人员之间的沟通，家庭,专科姑息治疗人员和初级保健。这提高了住院医师的护理质量,使居民能够在他们喜欢的地方得到照顾和死亡，并通过增加亲属对护理质量的信心而受益。
■共同设计和实现可扩展的英国需求循环模型。
■使用卫生服务研究实施综合促进行动框架的务实实施研究。
■在六个案例研究站点（英格兰，n=4，苏格兰，n=2）包括专科姑息治疗服务，每个护理院与三到六个护理院合作。
■第一阶段：访谈(n=28名护理院工作人员，专科姑息治疗人员，亲戚,初级保健,急性护理和专职保健医生)和四个讲习班(n=43名养老院工作人员，来自专科姑息治疗团队以及患者和公众参与和参与代表的临床医生和经理)。第2阶段：访谈（n=58护理院和姑息护理专业人员）；家庭问卷（n=13亲戚）；工作人员问卷（n=171护理院工作人员）；死亡/死亡质量问卷（n=81）；患者和公众参与和参与评估访谈（n=11）；保真度评估（n=14个需求查询记录）。
■(1)每月一小时的居民物理讨论，社会心理和精神需求，除了基于案例的学习，（2）临床工作和（3）相关/多学科小组会议。
■一种程序理论，描述了在英国需要的情况下对谁有效。次要结果侧重于卫生服务使用和成本效益，死亡和死亡的质量，养老院员工的信心和能力，以及使用患者和公众的参与和参与。
■与六个地点的主要利益相关者进行半结构化访谈和研讨会；采用姑息方法的能力，死亡质量和死亡指数，和加拿大医疗保健评估项目精简版问卷；需求汇总记录；有关居民人口统计/医疗服务使用的养老院数据；由需求汇总引发的评估和干预措施；与学术和患者以及公众参与和参与成员的半结构化访谈。
■计划理论：虽然养老院员工经历了诸如高更替等劳动力挑战，可变的技能和信心，需求查房可以为护理院和专业姑息治疗人员提供在受保护时间内进行合作的机会，计划居民生活的最后几个月。需求调查建立护理院员工的信心，并可以加强关系和信任，同时利用服务互补的专业知识。需求回合加强了对死亡的理解，症状管理,提前/预期护理计划和沟通。这可以改善住院医师的护理，使居民能够在他们喜欢的地方得到照顾和死亡，并可能通过增加亲属对护理质量的信心而受益。
■COVID-19限制干预和数据收集。由于样本量不足，无法对需求汇总进行成本效益分析,也无法计算治疗效果或家庭对护理的看法.
■我们的工作表明，需求统计可以改善养老院居民的生活和死亡质量，通过提高员工的技能和信心，包括症状管理，与全科医生和亲属的沟通，并加强疗养院和专业姑息治疗人员之间的关系。
■进行成本效益和治疗效果分析。与专员和政策制定者的互动可以检查将需求调查纳入整个英国的养老院和初级保健，以确保公平获得专科护理。
■本研究注册为ISRCTN15863801。
■该奖项由国家健康与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：NIHR128799）资助，并在健康与社会护理提供研究中全文发表。12号19.有关更多奖项信息，请参阅NIHR资助和奖励网站。
疗养院居民通常无法从临终关怀团队获得临终关怀，因此如果疗养院工作人员不能完全满足他们的需求，可能会在临终时经历痛苦的症状。我们研究了如何在英国使用在澳大利亚行之有效的称为“姑息治疗需求汇总”（或“需求汇总”）的方法。我们采访了28人(养老院工作人员，临终关怀人员和社区中的其他国家卫生服务/社会护理专业人员）关于他们对英国环境的理解，什么可能有助于触发变化，以及他们想要什么结果。我们在43人的在线研讨会上讨论了这些采访，在那里我们开始发展一种“什么会起作用”的理论，为谁,在什么情况下“并确定英国的需求回合会是什么样子。六项专科姑息治疗服务,每个都与三到六个当地护理院合作，使用了一年的需求回合。我们收集了养老院居民的信息，员工使用需求查询的经验，亲属对护理质量的看法，工作人员对居民死亡质量的看法，以及他们为居民提供姑息治疗的能力。我们发现，需要查房可以为护理院工作人员和专业姑息护理工作人员提供在受保护的时间内一起工作的机会，计划居民最后几个月的生活。需求调查建立护理院员工的信心，并可以加强关系和信任，同时使用每个服务的专业知识。需求回合加强了对死亡的理解，症状管理,提前/预期护理计划和养老院工作人员之间的沟通，家庭,专科姑息治疗人员和初级保健。这提高了住院医师的护理质量,使居民能够在他们喜欢的地方得到照顾和死亡，并通过增加亲属对护理质量的信心而受益。
