Tung Ericka E, Wieland Mark L, Verdoorn Brandon P, Mauck Karen F, Post Jason A, Thomas Matthew R, Bundrick John B, Jaeger Thomas M, Cha Stephen S, Thomas Kris G
1Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Am J Hosp Palliat Care. 2014 May;31(3):275-80. doi: 10.1177/1049909113485636. Epub 2013 Apr 15.
Many primary care providers feel uncomfortable discussing end-of-life care. The aim of this intervention was to assess internal medicine residents' advance care planning (ACP) practices and improve residents' ACP confidence. Residents participated in a facilitated ACP quality improvement workshop, which included an interactive presentation and chart audit of their own patients. Pre- and postintervention surveys assessed resident ACP-related confidence. Only 24% of the audited patients had an advance directive (AD), and 28% of the ACP-documentation was of no clinical utility. Terminally ill patients (odds ratio 2.8, P < .001) were more likely to have an AD. Patients requiring an interpreter were less likely to have participated in ACP. Residents reported significantly improved confidence with ACP and identified important training gaps. Future studies examining the impact on ACP quality are needed.
许多初级保健提供者在讨论临终护理时感到不自在。本干预措施的目的是评估内科住院医师的预先护理计划（ACP）实践情况，并提高住院医师对ACP的信心。住院医师参加了一次有指导的ACP质量改进研讨会，其中包括一次互动式讲座以及对他们自己患者的病历审查。干预前后的调查评估了住院医师与ACP相关的信心。在接受审查的患者中，只有24%有预先指示（AD），且28%的ACP文件没有临床实用性。绝症患者（优势比2.8，P<.001）更有可能有AD。需要口译员的患者参与ACP的可能性较小。住院医师报告称对ACP的信心显著提高，并发现了重要的培训差距。未来需要开展研究以检验对ACP质量的影响。
