Brazil Kevin, Carter Gillian, Galway Karen, Watson Max, van der Steen Jenny T
School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Ireland.
Northern Ireland Hospice, 18 O'Neill Road, Newtownabbey, BT36 6WB, Ireland.
BMC Palliat Care. 2015 Apr 23;14:14. doi: 10.1186/s12904-015-0019-x.
Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care.
A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented.
One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed.
Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.
预先护理计划（ACP）有助于沟通和理解患者偏好，但在初级保健中ACP的使用率较低。痴呆症病程的不确定性以及无法与痴呆症患者进行沟通，是全科医生发起关于护理目标讨论的重大挑战。
采用横断面调查，对北爱尔兰有登记痴呆症患者的全科医生进行了有目的的整群抽样。选定诊所的全科医生收到了调查问卷，并进行了多达四次邮件联系。
133名全科医生（40.6%）参与了调查，占被调查诊所的60.9%。虽然大多数受访者将痴呆症视为绝症（96.2%），但只有37.6%的人认为从诊断到重度痴呆症阶段都应同样适用姑息治疗。虽然大多数受访者认为早期讨论会有助于晚期痴呆症阶段的决策制定（61%），但对于是否应在诊断时启动ACP，受访者存在分歧。虽然大多数受访者认为全科医生应主动介绍和鼓励ACP，但大多数调查参与者承认，需要提高知识水平，以便让家庭参与到痴呆症患者临终护理中，并且需要一个ACP文件的标准格式。
ACP讨论的最佳时机应由患者和家庭照顾者面对生命末期的准备程度来决定。针对患者和家庭照顾者的教育策略可以加强ACP讨论，使他们在考虑未来护理选择时能够与全科医生共同做出决策。
