Issues Affecting Utilization of Hospice Services by Rural Hispanics

Abstract

As the population of Hispanics in the U.S. is growing, their utilization of hospice care remains low. In a study of 110 rural His-panics, most (88%) were not familiar with hospice, but did report willingness to accept such service in their homes. The most important possible barrier to receiving hospice care was language, along with poverty, lack of health insurance, and low levels of education. Hospice social workers can contribute greatly to an effort to increase access to hospice by offering education to the Hispanic community and promoting cultural awareness among hospice staff.     

本土社会工作介入临终服务领域的两种路径

20世纪80年代以来临终服务事业逐渐进入国内学界和公众视野。社会工作作为专门助人专业,在介入和推动中国临终关怀服务事业中,医务社会工作者应发挥积极效用。同时,从本土社会工作视角介入当前临终服务领域的路径除了要关注临终关怀,还要发展死亡教育事业。对临终关怀的探讨,在本土语境中利于扩大社会工作专业的服务范围,对社会工作学科的发展也具有积极的建设性意义。     

从社会工作视角看我国临终关怀团队的建设路径

当前我国的临终关怀护理团队呈现以护理人员为主,社会工作者严重缺失的特点。通过借鉴美国卡罗莱那州临终关怀建设的先进经验,提出我国临终关怀团队建设的本土化路径,认为:应围绕医护专业和社会工作专业两条主线,在社会工作专业中增设临终护理课程,在护理专业中融入社会工作模块,培养交叉学科背景下的专业临终关怀人才。     

基督教与现代临终关怀的理念与实践

作为现代医疗体系一部分的临终关怀主要出现和发展于西方社会,其中,西方社会文化中的基督教信仰传统为其提供了重要的思想资源,以及实践的建制、人员和场所。基督教对临终关怀的提供者,以及对于作为其信徒的临终者和亲属所提供的关于生死问题的信仰关怀和安慰,都与其教义和信仰实践有着紧密的关联。了解基督教在历史上以及现代实践中如何影响了现代临终关怀理念和实践,有助于更为全面和深刻地理解现代临终关怀,进而更适切地展开临终关怀服务。     

A study to determine if and how bereavement support programs provided by Irish and Canadian hospices are evaluated

A study of the bereavement programs provided by hospices in Ireland and the Canadian province of Alberta was done to determine if and how these are evaluated for efficacy. All but one hospice offered multiple different bereavement programs, with routine in-house evaluations of all programs performed. In all cases, staff and client unsolicited and solicited comments made during and at the end of each program provided data for continuing program refinement. Most hospices also routinely employed a self-devised questionnaire to gain specific sought information to retain or change programs. Other information, including news about program developments elsewhere, was also actively sought for program adoption or for the improvement of existing programs. With most bereavement programs having been in place for many years, participants were confident their programs are needed, safe, and effective. Their continuing quest for high-quality programming, however, meant they were active in monitoring these programs and in seeking developments in this field.     

人类学视野中的临终关怀

现代意义上临终关怀的重点是以控制症状为主,护理照料为中心的全方位服务。在以医学为主角的临终关怀服务团队中,渐渐渗透了包括人类学、社会学、心理学、伦理学等社会科学视角。实质上,在临终关怀尚未制度化时,人文社会科学就已切入这一领域的研究,而且并未将问题意识局限在量化的临终阶段①,而是延展至疾病、生死、制度、秩序、习俗、仪式等最重要的社会表象,并探究其背后的社会组织与结构及其相配合的社会人格、族群心理和集体情感等层面。人类学关于这一问题的理论和实践是本文论述的重点。     

Unmet Needs at the End of Life

Abstract

Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient-related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs.     

Hospice and Self-Assessed Quality of Life in the Dying: A Review

This review summarizes the impact of hospice and palliative end-of-life care on the self-assessed quality of life (QoL) in terminally ill persons. Articles were included if researchers utilized at least two observations post–hospice admission and were published in English between January of 2000 and December 2012. Findings from included studies synthesize results of a variety of terminal patients (n = 1,017) across settings. Only one study utilized a non-treatment control group. The remaining studies compared variations of program inclusions, settings, or QoL scores across carcinoma site. The studies included indicated mixed outcomes related to the effect of hospice on QoL in the dying.     

医务社会工作者如何介入临终关怀

随着社会的不断进步,越来越多的人开始意识到医务社会工作在医院工作中的重要性。医务社会工作者从专业角度和人文关怀的角度介入临终关怀,在很大程度上提高了临终病人的生命质量。     

老龄化背景下对宗教临终关怀需求的解读

生老病死是人生的自然发展过程,临终关怀又被称为安宁医护,或善终服务。在人生的最后时刻,保持乐观、积极的生活态度,维持作为人的尊严是临终关怀的根本意义所在,全球癌症发病率的持续升高和世界人口的老龄化趋势促使了现代临终关怀的产生。随着老龄化时代的到来,老年人群多元临终关怀需求大量增加,部分老人选择借助对宗教的信仰解除对死亡的恐惧,达到自己及亲属精神上的宁静与平和。通过对宗教临终关怀的解读,可以进一步了解老年人群对临终关怀的多元精神需求,是对我国构建和完善临终关怀服务体系的有机补充。