Ampe Sophie, Sevenants Aline, Smets Tinne, Declercq Anja, Van Audenhove Chantal
KU Leuven, LUCAS, Centre for Care Research and Consultancy, Belgium.
Vrije Universiteit Brussel, End-of-Life Care Research Group, Belgium.
J Adv Nurs. 2016 Mar;72(3):569-81. doi: 10.1111/jan.12854. Epub 2015 Nov 12.
The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning.
Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning.
Observational cross-sectional study in 20 nursing homes.
The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families).
June 2013-September 2013.
Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice.
The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice.
本研究的目的是：评估养老院中痴呆症患者的预立医疗计划政策；深入了解痴呆症患者及其家属在预立医疗计划中的参与情况，以及该政策与预立医疗计划实际实施之间的关系。
通过预立医疗计划，患有痴呆症的养老院居民参与护理决策，以应对其决策能力下降的情况。然而，这一群体很少能真正实现预立医疗计划。已有研究对其患病率和结果进行了探讨，但几乎没有研究关注居民/家属在预立医疗计划中的参与情况。
对20家养老院进行观察性横断面研究。
预立医疗计划审核评估了养老院工作人员对预立医疗计划政策的看法。此外，还根据“预立医疗计划标准”（预立医疗计划的实现情况）和“OPTION”工具（居民/家属的参与情况）对个人谈话进行了分析。
2013年6月至2013年9月。
养老院总体上符合预立医疗计划政策预先定义标准的四分之三。在几乎一半的谈话中，对预立医疗计划进行了实质性的解释和讨论。一般来说，医疗保健专业人员仅设法让居民/家属达到基本技能水平的参与程度。政策与实践之间没有统计学上的显著相关性。
对该政策的评估前景良好，但实际实施情况需要改进。建议对政策和实践进行未来评估。进一步的研究应侧重于在日常实践中实施预立医疗计划的沟通干预措施。
