Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.
J Am Geriatr Soc. 2014 Jul;62(7):1304-9. doi: 10.1111/jgs.12894. Epub 2014 Jun 16.
To examine whether experiences with illness and end-of-life care are associated with readiness to participate in advance care planning (ACP).
Observational cohort study.
Community.
Persons aged 60 and older recruited from physician offices and a senior center.
Participants were asked about personal experience with major illness or surgery and experience with others' end-of-life care, including whether they had made a medical decision for someone dying, knew someone who had a bad death due to too much or too little medical care, or experienced the death of a loved one who made end-of-life wishes known. Stages of change were assessed for specific ACP behaviors: completion of living will and healthcare proxy, communication with loved ones regarding life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same topics. Stages of change included precontemplation, contemplation, preparation, and action or maintenance, corresponding to whether the participant was not ready to complete the behavior, was considering participation in the next 6 months, was planning participation within 30 days, or had already participated.
Of 304 participants, 84% had one or more personal experiences or experience with others. Personal experiences were not associated with greater readiness for most ACP behaviors. In contrast, having one or more experiences with others was associated with greater readiness to complete a living will and healthcare proxy, discuss life-sustaining treatment with loved ones, and discuss quantity versus quality of life with loved ones and with physicians.
Older individuals who have experience with end-of-life care of others demonstrate greater readiness to participate in ACP. Discussions with older adults regarding these experiences may be a useful tool in promoting ACP.
探讨疾病和临终关怀体验是否与参与预先护理计划（ACP）的准备程度相关。
观察性队列研究。
社区。
从医生办公室和高级中心招募的 60 岁及以上的人。
参与者被问及个人经历重大疾病或手术以及他人临终关怀的经历，包括是否为即将去世的人做出过医疗决策，是否认识因医疗护理过多或过少而导致死亡质量较差的人，或是否经历过亲人表达过临终意愿的死亡。评估特定 ACP 行为的改变阶段：完成生前遗嘱和医疗代理、与亲人就维持生命的治疗和生命质量的数量与质量进行沟通，以及与医生就这些相同的话题进行沟通。改变阶段包括未考虑、考虑、准备和行动或维持，对应于参与者是否还没有准备好完成该行为、是否正在考虑在接下来的 6 个月内参与、是否计划在 30 天内参与，还是已经参与了。
在 304 名参与者中，84%的人有一个或多个个人经历或他人的经历。个人经历与大多数 ACP 行为的准备程度没有相关性。相比之下，有一个或多个他人的经历与完成生前遗嘱和医疗代理、与亲人讨论维持生命的治疗、与亲人以及与医生讨论生命质量的数量与质量的准备程度更高相关。
有他人临终关怀经验的老年人更愿意参与 ACP。与老年人讨论这些经验可能是促进 ACP 的有用工具。
