Construction Of Palliative Care Model For Inpatients With End-Stage Liver Disease

Objectives To describe the hospitalization experience of patients with end-stage liver disease and the need for palliative care,to explore the understanding of palliative care for liver disease specialists,to construct a palliative care model for patients with end-stage liver disease through Delphi expert consultation.In order to provide a scientific and effective theoretical basis for the development of palliative care for patients with end-stage liver disease,and promote the improvement of the quality of palliative care for hepatic diseases.Methods Using the phenomenological research method and grounded theory in the qualitative research method,21 semi-structured in-depth interviews were conducted among 11 hospitalized patients with end-stage liver disease and 10 hepatic specialists.The collected data were analyzed through Colaizzi’s 7-step method,and the three-level coding,writing of memos,the continuous comparison method respectively.Based on the analysis of interview materials,with the help of Orlando nursing theory and Maslow’s hierarchy of needs,combined with literature research and group discussion,two rounds of Delphi expert consultation were conducted to construct a palliative care model for patients with end-stage liver disease.Results 1.The hospitalization experience of patients with end-stage liver disease includes five aspects: the difficulty in adapting to the role;inner suffering,helplessness;fear of discrimination,eager to care;gratitude and embarrassment,worry about the future;believe in fate,let it be.At the same time,there is palliative care need for professional guidance,a quiet and convenient living environment,respect,understanding and care,spiritual comfort,and home care,involving physical,psychological,social and environmental aspects.2.Data analysis of liver disease specialists revealed three main categories,including awareness of palliative care,focus of carrying out palliative care,and development and implementation perspectives.The medical staffs believe that palliative care is important and urgent,and patients and their families should be given understanding and support in order to alleviate their physical and mental pain.The emphasis of clinical palliative care is on the prognosis of the disease course,family assessment and the use of communication strategies.To develop palliative care,multidisciplinary teams should be established,study and training should be strengthened,medical and environmental safety issues should be emphasized,and community health service resources should be made full use.3.A total of 19 experts participated in the Delphi expert consultation,with the expert authority coefficient was 0.886.The effective recovery rate of the two rounds of expert consultation questionnaires were 86.4%,100% respectively;the coordination coefficient of expert opinions at all levels was 0.161~0.271,with statistical significance(P < 0.001).4.In the first round of expert consultation,according to the dimension deletion criteria and expert advice,delete 2 tertiary-specific items;add 2 secondary dimensions,8 tertiary-specific items;modify 1 secondary dimension,14 tertiary-specific items.On the basis of the first round of revision,the second round of expert consultation revised 8 tertiary-specific items.After 2 rounds of expert consultation,the final palliative care model for patients with end-stage liver disease was constituted,included 7 first dimensions,24 secondary dimensions and 76 tertiary-specific items.5.The seven first dimensions of palliative care model for inpatients with end-stage liver disease include the establishment of palliative care group,inclusion of nursing objects,comprehensive evaluation,communication and collaboration,formulation of nursing plans,implementation of palliative care,and evaluation and continuous improvement,among which the "communication and collaboration" has the highest weight(0.173).Conclusions Based on the results of semi-structured interviews,this study used literature and theoretical research to construct a palliative care model for patients with end-stage liver disease through Delphi expert consultation.The results of the consultation were reliable,and the palliative care model of hospitalized patients with end-stage liver disease was scientific and reasonable,which can provide a reference for the implementation of palliative care for patients with end-stage liver disease.In the future,it is necessary to further verify and revise the palliative care model of hospitalized patients with end-stage liver disease,and improve the dimensions and items of palliative care model,so as to improve the quality of palliative care services for patients with end-stage liver disease.