Section of Mental Health and Ageing, Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
PLoS One. 2013 Apr 10;8(4):e60412. doi: 10.1371/journal.pone.0060412. Print 2013.
End-of-life-care is often poor in individuals with dementia. Advanced care planning (ACP) has the potential to improve end-of-life care in dementia. Commonly ACP is completed in the last six months of life but in dementia there may be problems with this as decision-making capacity and ability to communicate necessarily decrease as the disease progresses. Choosing the right time to discuss ACP with people with dementia may be challenging given the duration of the illness may be up to nine years.
To explore the acceptability of discussing ACP with people with memory problems and mild dementia shortly after diagnosis.
In-depth interviews were conducted with 12 patients and eight carers who had participated in ACP discussions and six staff members from a memory clinic and a community mental health team who had either conducted or attended the discussions for training purposes.
Patients and carers found ACP a positive intervention that helped them think about the future, enabled people with dementia to make their wishes known, and resulted in their feeling relieved and less worried about the future. The importance of sharing the ACP documentation between health service providers was highlighted.
This qualitative evaluation of ACP in early dementia has encouragingly positive results which support the wider application of the intervention in memory services and community mental health teams. Strategies are suggested to support the implementation of ACP further in clinical practice.
痴呆患者的临终关怀往往较差。先进的护理计划（ACP）有可能改善痴呆患者的临终关怀。通常情况下，ACP 是在生命的最后六个月内完成的，但在痴呆症中，由于决策能力和沟通能力随着疾病的进展必然下降，这可能会出现问题。考虑到疾病的持续时间可能长达九年，因此，对于患有痴呆症的人来说，选择合适的时间讨论 ACP 可能具有挑战性。
探索在诊断后不久与有记忆问题和轻度痴呆症的人讨论 ACP 的可接受性。
对 12 名患者和 8 名护理人员进行了深入访谈，他们参与了 ACP 讨论，对来自记忆诊所和社区心理健康团队的 6 名工作人员进行了访谈，他们出于培训目的进行了或参加了讨论。
患者和护理人员认为 ACP 是一种积极的干预措施，有助于他们思考未来，使痴呆症患者能够表达自己的意愿，并使他们感到安心，减少对未来的担忧。强调了在卫生服务提供者之间共享 ACP 文件的重要性。
这项对早期痴呆症中 ACP 的定性评估结果令人鼓舞，支持在记忆服务和社区心理健康团队中更广泛地应用该干预措施。提出了一些策略来支持在临床实践中进一步实施 ACP。
