Tigert Judy, Chaloner Nancy, Scarr Brenda, Webster Kathy
London Health Sciences Centre, London, Ontario.
CANNT J. 2005 Jan-Mar;15(1):20-4.
The proportion of patients starting renal replacement therapy who are elderly, dependent and have multiple co-morbidities is the fastest growing chronic kidney disease (CKD) population in Canada. Most professional nephrology organizations recommend that hemodialysis patients should be encouraged to write advance directives (AD). Advance directives or advance care planning (ACP) are terms that refer to instructions given by an individual that state his or her wishes for future medical treatment and personal care. ACP discussions occur infrequently between the hemodialysis patient and the health care team. Failure to initiate ACP discussions is often due to barriers such as comfort level, time constraints and lack of privacy. This paper reports the results of a small (n = 30) continuous quality improvement (CQI) initiative examining the effectiveness of developing and using a pamphlet to introduce the topic of AD with hemodialysis patients and their families. In this study, it was found that many hemodialysis patients have thought about cardiopulmonary resuscitation (46.6%), mechanical ventilation (63.3%) and withdrawal of dialysis (56.6%). The majority of hemodialysis patients (70%) found that a pamphlet is helpful to introduce the topic of AD. As a consequence of this CQI initiative, our renal program has further revised the pamphlet and is beginning to incorporate its use in patient care within the hemodialysis unit.
在加拿大，开始接受肾脏替代治疗的患者中，老年人、生活不能自理且患有多种合并症的患者群体是增长最快的慢性肾脏病（CKD）人群。大多数专业肾脏病学组织建议，应鼓励血液透析患者撰写预先医疗指示（AD）。预先医疗指示或预先护理计划（ACP）是指个人给出的关于其未来医疗治疗和个人护理意愿的指示。血液透析患者与医疗团队之间很少进行ACP讨论。未能启动ACP讨论通常是由于舒适度、时间限制和缺乏隐私等障碍。本文报告了一项小型（n = 30）持续质量改进（CQI）举措的结果，该举措旨在研究编写并使用一本小册子向血液透析患者及其家属介绍AD主题的有效性。在这项研究中，发现许多血液透析患者已经考虑过心肺复苏（46.6%）、机械通气（63.3%）和停止透析（56.6%）。大多数血液透析患者（70%）认为一本小册子有助于介绍AD主题。作为这项CQI举措的结果，我们的肾脏项目进一步修订了这本小册子，并开始将其纳入血液透析单元的患者护理工作中。
