开发一种复杂干预措施，以支持全科医生对处于病情恶化或濒死风险的患者启动预先护理计划：一项0-1期研究。
Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study.
作者信息
De Vleminck Aline, Houttekier Dirk, Deliens Luc, Vander Stichele Robert, Pardon Koen
机构信息
End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.
Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
出版信息
BMC Palliat Care. 2016 Feb 11;15:17. doi: 10.1186/s12904-016-0091-x.
BACKGROUND
Most patients with life-limiting illnesses are treated and cared for over a long period of time in primary care and guidelines suggest that ACP discussions should be initiated in primary care. However, a practical model to implement ACP in general practice is lacking. Therefore, the objective of this study is to develop an intervention to support the initiation of ACP in general practice.
METHODS
We conducted a Phase 0-I study according to the Medical Research Council (MRC) Framework. Phase 0 consisted of a systematic literature review about the barriers and facilitators for GPs to engage in ACP, focus groups with GPs were held about their experiences, attitudes and concerns regarding initiating ACP in general practice and a review of ACP interventions to identify potential components for the development of our intervention. In Phase 1, we developed a complex intervention to support the initiation of ACP in general practice in patients at risk of deteriorating or dying, based on the results of Phase 0. The complex intervention and its components were reviewed and refined by two expert panels.
RESULTS
Phase 0 resulted in the identification of the factors inhibiting or enabling GPs' initiation of ACP and important components underpinning existing ACP interventions. Based on these findings, an intervention was developed in Phase 1 consisting of: (1) a training for GPs in initiating and conducting ACP discussions, (2) a register of patients eligible for ACP discussions, (3) an educational booklet on ACP for patients to prepare the ACP discussions that includes general information on ACP, a section on the role of GPs in the process of ACP and a prompt list, (4) a conversation guide to support GPs in the ACP discussions and (5) a structured documentation template to record the outcomes of discussions.
CONCLUSION
Taking into account the barriers and facilitators for GPs to initiate ACP as well as the key factors underpinning successful ACP intervention in other health care settings, a complex intervention for general practice was developed, after gaining feedback from two expert panels. The feasibility and acceptability of the intervention will subsequently be tested in a Phase II study.
背景
大多数患有危及生命疾病的患者在基层医疗中接受长期治疗和护理，指南建议应在基层医疗中启动预立医疗照护计划（ACP）讨论。然而，在全科医疗中实施ACP的实用模式尚不存在。因此，本研究的目的是开发一种干预措施，以支持在全科医疗中启动ACP。
方法
我们根据医学研究理事会（MRC）框架进行了一项0-I期研究。0期包括对全科医生参与ACP的障碍和促进因素进行系统的文献综述，就他们在全科医疗中启动ACP的经验、态度和担忧举行焦点小组讨论，并对ACP干预措施进行综述，以确定我们干预措施开发的潜在组成部分。在1期，我们根据0期的结果，开发了一种复杂的干预措施，以支持在病情恶化或濒死风险患者的全科医疗中启动ACP。该复杂干预措施及其组成部分由两个专家小组进行了审查和完善。
结果
0期确定了抑制或促进全科医生启动ACP的因素以及现有ACP干预措施的重要组成部分。基于这些发现，在1期开发了一种干预措施，包括：（1）针对全科医生启动和进行ACP讨论的培训；（2）符合ACP讨论条件患者的登记册；（3）一本面向患者的关于ACP的教育手册，用于准备ACP讨论，其中包括关于ACP的一般信息、全科医生在ACP过程中的作用部分以及提示清单；（4）支持全科医生进行ACP讨论的对话指南；（5）用于记录讨论结果的结构化文档模板。
结论
考虑到全科医生启动ACP的障碍和促进因素以及其他医疗环境中成功的ACP干预措施的关键因素，在获得两个专家小组的反馈后，开发了一种针对全科医疗的复杂干预措施。随后将在II期研究中测试该干预措施的可行性和可接受性。
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