Ahluwalia Sangeeta C, Bekelman David B, Huynh Alexis K, Prendergast Thomas J, Shreve Scott, Lorenz Karl A
Oregon State University, Corvallis, OR, USA VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Am J Hosp Palliat Care. 2015 Dec;32(8):817-23. doi: 10.1177/1049909114541513. Epub 2014 Jul 2.
Early and repeated patient-provider conversations about advance care planning (ACP) are now widely recommended. We sought to characterize barriers and strategies for realizing an iterative model of ACP patient-provider communication.
A total of 2 multidisciplinary focus groups and 3 semistructured interviews with 20 providers at a large Veterans Affairs medical center. Thematic analysis was employed to identify salient themes.
Barriers included variation among providers in approaches to ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. Strategies included eliciting patient values rather than specific treatment choices and an increased role for primary care in the ACP process.
Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum.
现在广泛推荐就预先医疗计划（ACP）与患者进行早期且反复的沟通。我们试图明确实现ACP患者与医疗服务提供者沟通的迭代模式的障碍和策略。
在一家大型退伍军人事务医疗中心，对20名医疗服务提供者进行了总共2次多学科焦点小组讨论和3次半结构化访谈。采用主题分析法来确定突出主题。
障碍包括医疗服务提供者在ACP方法上的差异、缺乏有关患者价值观以指导决策的有用信息，以及不同环境下医疗服务提供者之间的无效沟通。策略包括引出患者价值观而非具体治疗选择，以及在ACP过程中增加初级保健的作用。
更多地关注在整个连续过程中连接医疗服务提供者、最大化电子健康记录的潜力，以及将患者经历与他们的价值观联系起来，可能有助于在整个连续过程中连接ACP沟通。
