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Originalarbeit

Implementierung des KOMMA-Ansatzes zur Unterstützung von Angehörigen in der häuslichen Palliativversorgung

Evaluationsergebnisse

Published Online:February 14, 2024https://doi.org/10.1024/1012-5302/a000981

Abstract

Zusammenfassung.Hintergrund: Die Unterstützung der Angehörigen in der ambulanten Hospizarbeit und Palliativversorgung erfolgt meist wenig systematisch. In einem dreijährigen Modellprojekt wurde mit der Carer Support Needs Assessment Tool-Intervention (CSNAT-I; dt. KOMMA-Ansatz) ein evidenzbasierter personenzentrierter Ansatz zur Unterstützung von Angehörigen in drei Projektregionen in Nordrhein-Westfalen umgesetzt und evaluiert. Ziel: Den Implementierungsprozess und Faktoren, die auf diesen Einfluss hatten, darzustellen. Methoden: Der für den deutschsprachigen Raum adaptierte KOMMA-Ansatz wurde mithilfe von Multiplikatorinnen in sechs ambulanten Hospizdiensten und Teams der spezialisierten ambulanten Palliativversorgung (SAPV) umgesetzt. Die Evaluation erfolgte anhand der Normalization Process Theory (NPT) mittels eines Mixed-Methods-Evaluations-Designs. Ergebnisse: Der KOMMA-Ansatz wurde dienstübergreifend erprobt, eine routinehafte Umsetzung konnte im eher kurzen Implementierungszeitraum aber nicht vollständig erreicht werden. Die Mitarbeiter_innen waren von der Sinnhaftigkeit des Ansatzes überzeugt, das Feedback der Angehörigen positiv oder unspezifisch. Die Praxis der Angehörigenarbeit veränderte sich, und das Thema Angehörige erhielt mehr Aufmerksamkeit. Barrieren zeigten sich bei der personenzentrierten Gesprächsführung mit Angehörigen sowie in organisationalen Routinen. Schlussfolgerungen: Der personenzentrierte KOMMA-Ansatz hat Potenzial, die Angehörigenarbeit in den Strukturen der Palliativversorgung im deutschsprachigen Raum zu professionalisieren. In den Diensten benötigt es dafür einen Kulturwandel.


Implementation of the German CSNAT-I to support family caregivers in palliative home care: Evaluation results

Abstract.Background: Supporting family carers in palliative home care mostly lacks a systematic approach. In a three-year model project, the Carer Support Needs Assessment Tool Intervention (CSNAT-I), an evidence-based person-centred approach for family caregiver support, was implemented and evaluated in three project regions in North Rhine-Westphalia. Aim: To present the implementation process and factors that impacted on it. Methods: The German CSNAT-I was adapted and subsequently implemented by six hospice services and specialised home palliative care teams with the assistance of champions. The evaluation was based on Normalization Process Theory (NPT) using a mixed methods evaluation design. Results: The German CSNAT-I was used across service boundaries, but routine implementation could not be fully achieved within the relatively short implementation timeframe. Staff members were convinced of the approach’s significance, and feedback from family caregivers was generally positive or non-specific. The practice of caregiver support evolved, and the importance of family caregivers received increased attention. Barriers emerged in person-centred communication with family caregivers and within organizational routines. Conclusion: The implementation showed that the person-centred intervention has the potential to enhance caregiver support in the German palliative home care setting. Implementing the CSNAT-I requires a cultural shift within the services.

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