Simon Jessica, Porterfield Pat, Bouchal Shelley Raffin, Heyland Daren
Division of Palliative Medicine, Department of Oncology and Department of Internal Medicine, University of Calgary, Alberta, Canada.
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Support Palliat Care. 2015 Mar;5(1):54-62. doi: 10.1136/bmjspcare-2013-000487. Epub 2013 Nov 19.
To explore seriously ill, older hospitalised patients' and their family members' perspectives on the barriers and facilitators of advance care planning (ACP).
We used qualitative descriptive study methodology to analyse data from an interviewer administered, questionnaire-based, Canadian multicentre, prospective study of this population.
Three main categories described these barriers and facilitators: (1) person (beliefs, attitudes, experiences, health status), (2) access (to doctors and healthcare providers, information, tools and infrastructure to communicate ACP preferences) and (3) the interaction with the doctor (who and how initiated, location, timing, quality of communication, relationship with doctor).
Based on the findings, we suggest strategies for both healthcare systems and individual healthcare providers to improve the quality and quantity of ACP with this population. These include assessing readiness for participation in ACP and personalising relevance of ACP to each individual, routinely offering scheduled family meetings for exploring a person's own goals and sharing information, ensuring systems and policies are in place to access previous ACP documentation and ensuring doctors' education includes ACP communication skills.
探讨住院的老年重症患者及其家庭成员对预先医疗计划（ACP）的障碍和促进因素的看法。
我们采用定性描述性研究方法，对一项基于问卷、由访员实施的加拿大多中心前瞻性研究中该人群的数据进行分析。
三类主要因素描述了这些障碍和促进因素：（1）个人（信念、态度、经历、健康状况），（2）获取途径（与医生和医疗服务提供者的接触、信息、传达ACP偏好的工具和基础设施）以及（3）与医生的互动（由谁发起及如何发起、地点、时间、沟通质量、与医生的关系）。
基于研究结果，我们为医疗系统和个体医疗服务提供者提出了提高针对该人群的ACP质量和数量的策略。这些策略包括评估参与ACP的意愿并使ACP与每个人的情况相关联，定期安排家庭会议以探讨个人目标并分享信息，确保有获取先前ACP文件的系统和政策，以及确保医生教育包括ACP沟通技巧。
