背景:确定患有慢性阻塞性肺疾病(COPD)的老年人的优先挑战对于设计旨在改善其健康和独立性的干预措施至关重要。
目的:优先考虑老年COPD患者及其护理者的挑战,以指导改善COPD患者及其家庭护理人员的电话护士教练干预措施(EPIC:赋予COPD患者独立性)。
方法:由Baltes成功衰老理论和5Ms框架指导的多阶段研究:第一阶段:标称分组技术(NGT),通过小组共识对问题的回答进行优先排序的结构化过程。第二阶段:快速定性分析。第三阶段:干预映射和细化。
方法:门诊,虚拟。
方法:患有COPD的老年人,家庭照顾者,诊所工作人员(护士,呼吸治疗师),临床医生(医生,执业护士),和卫生系统领导人。
结果:NGT会议由选区组进行,有37名参与者(n=7名患者,n=6名家庭照顾者,n=8名诊所工作人员,n=9名临床医生,n=7个卫生系统领导人)(第一阶段)。参与者在五个主题(第二阶段)上产生了92个陈述:(1)“护理障碍”,(2)“家庭照顾者需要”,(3)\“功能状态和移动性问题\”,(4)“疾病理解”,和(5)“COPD护理复杂性”。补充氧气的挑战成为一个关键问题,和优先挑战因群体而异。患者和诊所工作人员优先考虑“功能状态和行动问题”,家庭照顾者优先考虑“家庭照顾者需求”,临床医生和卫生系统领导人优先考虑“COPD护理复杂性”。干预映射(第3阶段)指导的EPIC细化侧重于满足患者的独立性和流动性优先事项,但考虑所有优先事项。
结论:不同的选民团体确定了患有COPD的老年人的优先挑战。功能状态和移动性问题,特别是与补充氧气有关,成为患者优先考虑的挑战。
结论:针对COPD老年人的以患者为中心的干预措施必须考虑其优先考虑的功能和补充氧气需求,并探索不同的构成观点以促进干预措施的丰富。
BACKGROUND: Identifying priority challenges of older adults with chronic obstructive pulmonary disease (COPD) is critical to designing interventions aimed at improving their well-being and independence.
OBJECTIVE: To prioritize challenges of older adults with COPD and those who care for them to guide refinement of a telephonic nurse coach intervention for patients with COPD and their family caregivers (EPIC: Empowering People to Independence in COPD).
METHODS: Multiphase
study guided by Baltes Theory of Successful Aging and the 5Ms Framework: Phase 1: Nominal group technique (NGT), a structured process of prioritizing responses to a question through group consensus. Phase 2: Rapid qualitative analysis. Phase 3: Intervention mapping and refinement.
METHODS: Ambulatory, virtual.
METHODS: Older adults with COPD, family caregivers, clinic staff (nurses, respiratory therapists), clinicians (physicians, nurse practitioners), and health system leaders.
RESULTS: NGT sessions were conducted by constituency group with 37 participants (n = 7 patients, n = 6 family caregivers, n = 8 clinic staff, n = 9 clinicians, n = 7 health system leaders) (Phase 1). Participants generated 92 statements across five themes (Phase 2): (1) \"Barriers to care\", (2) \"Family caregiver needs\", (3) \"Functional status and mobility issues\", (4) \"Illness understanding\", and (5) \"COPD care complexities\". Supplemental oxygen challenges emerged as a critical problem, and prioritized challenges differed by group. Patients and clinic staff prioritized \"Functional status and mobility issues\", family caregivers prioritized \"Family caregiver needs\", and clinicians and health system leaders prioritized \"COPD care complexities\". Intervention mapping (Phase 3) guided EPIC refinement focused on meeting patient priorities of independence and mobility but accounting for all priorities.
CONCLUSIONS: Diverse constituency groups identified priority challenges for older adults with COPD. Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient prioritized challenges.
CONCLUSIONS: Patient-centered interventions for older adults with COPD must account for their prioritized functional and supplemental oxygen needs and explore diverse constituent perspectives to facilitate intervention enrichment.