Bose-Brill Seuli, Kretovics Matthew, Ballenger Taylor, Modan Gabriella, Lai Albert, Belanger Lindsay, Koesters Stephen, Pressler-Vydra Taylor, Wills Celia
Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, Ohio State University, 895 Yard St, Columbus, OH 43212. E-mail:
Am J Manag Care. 2016 Jun;22(6):412-8.
End-of-life planning, known as advance care planning (ACP), is associated with numerous positive outcomes, such as improved patient satisfaction with care and improved patient quality of life in terminal illness. However, patient-provider ACP conversations are rarely performed or documented due to a number of barriers, including time required, perceived lack of skill, and a limited number of resources. Use of tethered personal health records (PHRs) may help streamline ACP conversations and documentations for outpatient workflows. Our objective was to develop an ACP-PHR framework that would be for use in a primary care, outpatient setting.
Qualitative content analysis of focus groups and cognitive interviews (participatory design).
A novel PHR-ACP tool was developed and tested using data and feedback collected from 4 patient focus groups (n = 13), 1 provider focus group (n = 4), and cognitive interviews (n = 22).
Patient focus groups helped develop a focused, 4-question PHR communication tool. Cognitive interviews revealed that, while patients felt framework content and workflow were generally intuitive, minor changes to content and workflow would optimize the framework.
A focused framework for electronic ACP communication using a patient portal tethered to the PHR was developed. This framework may provide an efficient way to have ACP conversations in busy outpatient settings.
临终规划，即所谓的预先护理规划（ACP），与众多积极结果相关，如提高患者对护理的满意度以及改善绝症患者的生活质量。然而，由于诸多障碍，包括所需时间、认为缺乏技能以及资源有限等，患者与医护人员之间的ACP对话很少进行或记录。使用绑定式个人健康记录（PHR）可能有助于简化门诊工作流程中的ACP对话和文档记录。我们的目标是开发一个适用于初级护理门诊环境的ACP - PHR框架。
焦点小组和认知访谈的定性内容分析（参与式设计）。
使用从4个患者焦点小组（n = 13）、1个医护人员焦点小组（n = 4）以及认知访谈（n = 22）收集的数据和反馈，开发并测试了一种新型的PHR - ACP工具。
患者焦点小组帮助开发了一个聚焦的、包含4个问题的PHR沟通工具。认知访谈表明，虽然患者认为框架内容和工作流程总体直观，但对内容和工作流程进行细微更改将优化该框架。
开发了一个使用绑定到PHR的患者门户进行电子ACP沟通的聚焦框架。该框架可能为在繁忙的门诊环境中进行ACP对话提供一种有效的方式。
