North Western Deanery, UK.
Palliat Med. 2013 Mar;27(3):265-72. doi: 10.1177/0269216312440606. Epub 2012 Mar 26.
Chronic obstructive pulmonary disease (COPD) is a major cause of death worldwide and there are concerns that end-of-life care for these patients is inadequate. Advance care planning is encouraged, with the hope that it will improve communication and avoid unwanted interventions, which have been particular concerns; in practice, these discussions rarely occur. We have little knowledge of the views of patients with COPD on advance care planning. Understanding this could help integrate advance care planning into the routine management of patients with COPD.
To explore the views of people with severe COPD about advance care planning.
Qualitative design, with data collection incorporating audio recorded semi-structured interviews. Analysis followed a grounded theory approach.
SETTING/PARTICIPANTS: Patients with severe COPD (n =10, Gold Standards Framework criteria) were recruited from primary and secondary care settings.
Participants felt they had not been given enough information about their diagnosis and prognosis, and were keen for more discussion with healthcare professionals. They wanted more involvement in decisions about their treatment when those decisions were required. Participants were happy to discuss their general views about future care, but felt uncomfortable with the traditional model of binding 'advance directives'.
Considering advance care planning as a repeated process of discussion of prognosis, concerns and probable preferences for care would be more useful than encouraging binding advance decisions. Further research should assess the effectiveness of this approach. Local coordination of who is responsible for information provision is needed, and greater involvement of patients with COPD in management decisions as they arise.
慢性阻塞性肺疾病（COPD）是全球主要的死亡原因之一，人们担心这些患者的临终关怀不足。鼓励进行预先护理计划，希望能改善沟通并避免不必要的干预，这些都是特别关注的问题；但实际上，这些讨论很少发生。我们对 COPD 患者对预先护理计划的看法知之甚少。了解这一点可以帮助将预先护理计划纳入 COPD 患者的常规管理。
探讨严重 COPD 患者对预先护理计划的看法。
定性设计，通过包含音频记录的半结构化访谈收集数据。分析遵循扎根理论方法。
设置/参与者：从初级和二级保健机构招募了 10 名严重 COPD 患者（符合黄金标准框架标准）。
参与者认为他们没有得到足够的关于他们的诊断和预后的信息，并且渴望与医疗保健专业人员进行更多的讨论。当需要做出治疗决策时，他们希望更多地参与这些决策。参与者乐于讨论他们对未来护理的一般看法，但对传统的绑定“预先指令”模式感到不舒服。
将预先护理计划视为对预后、关注点和可能的护理偏好的反复讨论过程，将比鼓励绑定预先决策更有用。应进一步研究这种方法的有效性。需要对负责信息提供的人员进行本地协调，并让更多的 COPD 患者参与管理决策的制定。
