Patient-centred care

以患者为中心的护理
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:女性受到骨关节炎(OA)的影响不成比例,但与男性相比,女性获得早期诊断和治疗的可能性较小,或体验通过以人为本的方法定制的OA护理,以满足他们的需求和偏好,特别是种族歧视的女性。支持临床医生优化OA护理的一种方法是通过临床指南。我们旨在审查OA指南的内容,以指导提供公平,对包括妇女在内的弱势群体提供以人为本的护理。
    方法:我们在索引数据库和网站上搜索了2000年或以后由非营利组织发布的英语OA相关指南。我们使用清单内容分析来提取数据,以及汇总统计数据和文本来描述指南特征,使用六域PCC框架的以人为中心的护理(PCC),OA患病率或交叉因素的障碍,以及改善获得OA护理的公平机会的策略。
    结果:我们纳入了2003年至2021年在8个地区或国家发布的36项OA指南。很少(39%)发展小组包括患者。虽然大多数(81%)指南至少包括一个PCC域,指导通常是简短或模糊的,很少有地址交换信息,对情绪做出反应并管理不确定性,没有人提到培养一种治愈的关系。少数(39%)的指南承认或描述了特定群体中OA的患病率较高;只有3%(8%)指出,社会经济地位是OA护理的障碍,只有2名(6%)向临床医生提供了如何改善OA护理公平获得的指导:评估可接受性,可用性,可访问性,和自我管理干预措施的可负担性;并采用风险评估工具来识别手术后无法在家中应对的患者。
    结论:这项研究表明,OA指南不支持临床医生照顾因影响获得和护理质量的交叉因素而面临劣势的不同OA患者。开发人员可以通过纳入可从现有框架和工具中提取的PCC和公平性指南来加强OA指南,并将不同的OA人员纳入指南制定小组。需要未来的研究来识别多层次(患者,临床医生,系统)可以通过指导方针或其他方式实施的战略,以提高公平性,以人为本的OA护理。
    这项研究是由一组研究人员通知的,合作者,和十三个有生活经验的不同女性,为规划做出了贡献,和数据收集,通过审查学习材料并提供口头(在会议期间)和书面(通过电子邮件)反馈进行分析和解释。
    BACKGROUND: Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women.
    METHODS: We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care.
    RESULTS: We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery.
    CONCLUSIONS: This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care.
    UNASSIGNED: This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.
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  • 文章类型: Journal Article
    虽然医疗保健越来越以患者为中心,基于证据的营养干预措施仍然无法对所有癌症患者实施.由于营养干预直接改善临床和社会经济结果,没有营养护理,以患者为中心的护理是不完整的。虽然意识到营养不良对临床结果的负面影响,生活质量,癌症患者的功能和情感健康正在增长,患者的意识相对较差,临床医生,政策制定者,和付款人的营养干预-特别是那些在疾病课程的早期阶段开始-是改善这种结果的有效方法。欧洲抗癌计划认识到需要对癌症采取整体方法,但缺乏在成员国层面实施综合营养癌症护理的可行建议。当考虑营养护理是一项人权时,必须优先考虑对生活质量和功能状态的影响,因为这些对病人来说同样重要,尤其是在晚期癌症中,可能无法改善生存率或肿瘤负担等临床结局。我们制定了区域和欧洲层面所需的行动,以确保为所有癌症患者提供综合营养护理。4个主要的回家信息如下:1.如果不将营养整合到整个癌症护理连续体中,欧洲癌症计划的目标就无法实现。2.营养不良对临床结果产生负面影响,并对患者和医疗保健系统产生社会经济后果。3.因此,将营养护理纳入癌症护理是临床医生的责任和道德责任(希波克拉底誓言-primumnonnocere)和4。营养护理是一种经济有效的,循证治疗。
    While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe\'s Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    HIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care.
    An international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice.
    From 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years.
    Adoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.
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  • 文章类型: Journal Article
    OBJECTIVE: To summarize what facilitates patient-centred care for adult patients in acute healthcare settings from evidence-based patient-centred care guidelines.
    METHODS: An integrative literature review.
    METHODS: The following data sources were searched between 2002-2020: Citation databases: CINAHL, Medline, Biomed Central, Academic Search Complete, Health Source: Nursing/Academic Edition and Google Scholar. Guideline databases: US National Guideline Clearinghouse, Guidelines International Network, and National Institute for Health and Clinical Excellence (NICE). Websites of guideline developers: Scottish Intercollegiate Guidelines Network, Royal College of Nurses, Registered Nurses Association of Ontario, New Zealand Guidelines Group, National Health and Medical Research Council, and Canadian Medical Association.
    CONCLUSIONS:
    METHODS: Whittemore and Knafl\'s five-step integrative literature review: (1) identification of research problem; (2) search of the literature; (3) evaluation of data; (4) analysis of data; and (5) presentation of results.
    RESULTS: Following critical appraisal, nine guidelines were included for data extraction and synthesis. The following three groups of factors were found to facilitate patient-centred care: 1) Patient care practices: embracing values foundational to patient-centred care, optimal communication in all aspects of care, rendering basic nursing care practices, and family involvement; 2) Educational factors: staff and patient education; and 3) Organizational and policy factors: organizational and managerial support, organizational champions, healthy work environment, and organizational structures promoting interdisciplinary partnership.
    CONCLUSIONS: Evidence from included guidelines can be used by nurses, with the required support and buy-in from management, to promote patient-centred care.
    CONCLUSIONS: Patient-centred care is essential for quality care. No other literature review has been conducted in the English language to summarize evidence-based patient-centred care guidelines. Patient care practices and educational, organizational, and policy factors promote patient-centred care to improve quality of care and raise levels of awareness of patient-centred care among nursing staff and patients.
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  • 文章类型: Journal Article
    背景:Takotsub综合征(TTS)是一种急性和可逆性类型的心力衰竭,与急性冠状动脉综合征具有共同特征。它通常是由心理或身体压力引起的,但是第三个,无法识别触发器。患者还患有残留症状和恢复期的心理健康下降,并且可能难以理解和管理日常生活。
    目的:描述患者受塔科特subo综合征折磨的经历,出院后。
    方法:使用定性方法和半结构化个人访谈的归纳探索性设计。根据Graneheim和Lundman的说法,使用定性内容分析对文本进行了分析。
    结果:10名女性和1名男性在出院后2至12个月接受了采访。确定了六个子类别,出现了一个主要类别:从症状发作和理解到提高意识和生活变化的过程。患者遭受情绪反应,他们寻求答案并了解根本原因。这种疾病导致患者日常生活的变化,因为他们受到身体和心理的影响。配偶和/或旁观者发挥了积极的支持作用,但患者需要更多的支持,从医疗保健专业人员,如早期预约随访与护士。
    结论:受TTS影响可导致生活条件的变化,但这些变化因患者而异。生病与急性身体压力和长期心理压力有关,他们遭受情绪反应。后续护理需要改进,因为患者需要医疗保健专业人员的更多指导,并需要提前预约护士进行后续护理。以人为本的结构化和多专业治疗方法可以支持患者的康复。
    BACKGROUND: Takotsubo syndrome (TTS) is an acute and reversible type of heart failure that shares common features with acute coronary syndrome. It is usually caused by psychological or physical stress, but for a third, triggers cannot be identified. Patients also suffer from residual symptoms and decreased mental health in the recovery phase and may struggle to comprehend and manage everyday living.
    OBJECTIVE: To describe patients\' experiences when afflicted by takotsubo syndrome, after discharge from hospital.
    METHODS: An inductive explorative design using a qualitative approach with semi-structured individual interviews. The text was analysed using qualitative content analysis according to Graneheim and Lundman.
    RESULTS: Ten women and one man afflicted by TTS were interviewed two to twelve months after discharge. Six sub-categories were identified, and a main category emerged: The process from symptom onset and understanding to increased awareness and changes in life. The patients suffered from emotional reactions and they sought answers and understanding about the underlying causes. The disease led to changes in patients\' daily lives as they were affected physically and psychologically. Spouses and/or bystanders had a positive supporting role, but the patients desired more support from the healthcare professionals such as an earlier appointment for follow-up with a nurse.
    CONCLUSIONS: Being afflicted by TTS can lead to changes in life conditions but these changes vary among patients. Becoming ill was associated to acute physical stress and prolonged psychological stress and they suffered from emotional reactions. The follow-up care needs to improve as the patients need more guidance from healthcare professionals and earlier appointment for follow-up with a nurse. A structured and multiprofessional treatment with a person-centred approach could support patients in their recovery.
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  • 文章类型: Journal Article
    Clinical guidelines optimize care delivery and outcomes. Guidelines support patient engagement and adherence if they reflect patient preferences for treatment options, risks and benefits. Many guidelines do not address patient preferences. Developers require insight on how to develop such guidelines.
    To conduct a scoping review on how to identify, incorporate and report patient preferences in guidelines.
    We searched MEDLINE, EMBASE, Scopus, CINAHL, OpenGrey and GreyLit from 2010 to November 2019.
    We included English language studies describing patient preferences and guidelines.
    We reported approaches for and determinants and impacts of identifying patient preferences using summary statistics and text, and interpreted findings using a conceptual framework of patient engagement in guideline development.
    Sixteen studies were included: 2 consulted patients and providers about patient engagement approaches, and 14 identified patient preferences (42.9%) or methods for doing so (71.4%). Studies employed single (57.1%) or multiple (42.9%) methods for identifying preferences. Eight (57.1%) incorporated preferences in one aspect of guideline development, while 6 (42.9%) incorporated preferences in multiple ways, most commonly to identify questions, benefits or harms, and generate recommendations. Studies did not address patient engagement in many guideline development steps. Included studies were too few to establish the best approaches for identifying or incorporating preferences. Fewer than half of the studies (7, 43.8%) explored barriers. None examined reporting preferences in guidelines.
    Research is needed to establish the single or multiple approaches that result in incorporating and reporting preferences in all guideline development steps.
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