姑息治疗医护人员对照顾有预立医疗指示患者的体验。

Palliative care health professionals' experiences of caring for patients with advance care directives.

作者信息

Johnson Claire E, Singer Rachel, Masso Malcolm, Sellars Marcus, Silvester William

机构信息

Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, M507, 35 Stirling Hwy, Crawley, WA 6009, Australia.

Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. Email.

出版信息

Aust Health Rev. 2015 Apr;39(2):154-159. doi: 10.1071/AH14119.

DOI:10.1071/AH14119

PMID:25607507

Abstract

OBJECTIVE

To explore the health professionals' (HPs) perceptions and experiences of advance care directives (ACDs) and advance care planning in Australian palliative care services.

METHODS

A nationwide survey of 105 palliative care services was conducted, with two HPs from each service invited to participate. A qualitative analysis of open responses about advance care planning was undertaken.

RESULTS

Sixty questionnaires were returned with open responses. Most responders were nurses (75%), aged ≥40 years (80%) and with a mean of 12 years palliative care experience. Data were grouped into four key themes: (1) the ACD; (2) the process of developing ACDs; (3) the process of using ACDs; and (4) the consequences of having ACDs. Participants were positive about advance care planning, commenting that ongoing communication about end-of-life care ensures mutual understanding between patients, family and HPs. Provision of care was considered easier and more efficient with an ACD in place. ACDs were perceived to reduce distrust and conflict between family, friends and HPs, and promote communication. Suboptimal documentation, clarity and explicitness limited the usefulness of ACDs when they were available.

CONCLUSIONS

Advance care planning benefits HPs, patients and their family. To maximise these benefits, ACDs need to be clear, comprehensive, medically relevant and transportable documents.

摘要

目的

探讨澳大利亚姑息治疗服务中医疗专业人员（HPs）对预立医疗指示（ACDs）和预立医疗计划的看法及经验。

方法

对105家姑息治疗服务机构进行了全国性调查，邀请每家机构的两名医疗专业人员参与。对有关预立医疗计划的开放式回答进行了定性分析。

结果

共收回60份带有开放式回答的问卷。大多数回答者是护士（75%），年龄≥40岁（80%），平均有12年的姑息治疗经验。数据分为四个关键主题：（1）预立医疗指示；（2）制定预立医疗指示的过程；（3）使用预立医疗指示的过程；（4）拥有预立医疗指示的后果。参与者对预立医疗计划持积极态度，认为就临终护理进行持续沟通可确保患者、家属和医疗专业人员之间的相互理解。有了预立医疗指示，护理工作会更容易且更高效。预立医疗指示被认为可减少家人、朋友和医疗专业人员之间的不信任和冲突，并促进沟通。当有预立医疗指示时，记录不佳、清晰度和明确性不足限制了其效用。