Integrating palliative care within acute stroke services: developing a programme theory of patient and family needs, preferences and staff perspectives

BMC Palliative Care

Correspondence

Sheila Payne¹  Christopher R Burton² 

[1] Division of Health Research, Faculty of Health and Medicine, Lancaster University, LA1 4YT, Lancaster, Lancashire, UK;School of Healthcare Sciences, Bangor University, LL57 2EF, Bangor Gwynedd, UK;

关键词: Acute stroke;    Palliative care;    Integration;    Synthesis;    Theory development;    End of life care;   

DOI  :  10.1186/1472-684X-11-22

 received in 2012-07-09, accepted in 2012-11-07,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPalliative care should be integrated early into the care trajectories of people with life threatening illness such as stroke. However published guidance focuses primarily on the end of life, and there is a gap in the evidence about how the palliative care needs of acute stroke patients and families should be addressed. Synthesising data across a programme of related studies, this paper presents an explanatory framework for the integration of palliative and acute stroke care.MethodsData from a survey (n=191) of patient-reported palliative care needs and interviews (n=53) exploring experiences with patients and family members were explored in group interviews with 29 staff from 3 United Kingdom stroke services. A realist approach to theory building was used, constructed around the mechanisms that characterise integration, their impacts, and mediating, contextual influences.ResultsThe framework includes two cognitive mechanisms (the legitimacy of palliative care and individual capacity), and behavioural mechanisms (engaging with family; the timing of intervention; working with complexity; and the recognition of dying) through which staff integrate palliative and stroke care. A range of clinical (whether patients are being ‘actively treated’, and prognostic uncertainty) and service (leadership, specialty status and neurological focus) factors appear to influence how palliative care needs are attended to.ConclusionsOur framework is the first, empirical explanation of the integration of palliative and acute stroke care. The specification in the framework of factors that mediate integration can inform service development to improve the outcomes and experiences of patients and families.

【 授权许可】

CC BY   
© Burton and Payne; licensee BioMed Central Ltd. 2012