Weathers Elizabeth, O'Caoimh Rónán, Cornally Nicola, Fitzgerald Carol, Kearns Tara, Coffey Alice, Daly Edel, O'Sullivan Ronan, McGlade Ciara, Molloy D William
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland; Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland.
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas rd, Cork, Ireland; Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland.
Maturitas. 2016 Sep;91:101-9. doi: 10.1016/j.maturitas.2016.06.016. Epub 2016 Jun 23.
Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors.
预先护理计划（ACP），即让患者、家属和医疗保健专业人员在预期决策能力受损之前，就未来的医疗保健决策进行讨论，这样既能提高满意度和临终护理水平，又能尊重患者自主权。它通常会产生一份书面的预先护理指示（ACD）。本系统评价考察了ACP对所有医疗环境中65岁以上老年人的多个结局（包括症状管理、护理质量和医疗保健利用情况）的影响。通过检索CINAHL、PubMed和Cochrane数据库，确定了9项随机对照试验（RCT）。总共纳入了3646名老年人（年龄范围72 - 88岁）。7项研究针对社区居民开展，另外2项RCT在养老院进行。大多数研究未实施标准化的ACD，也未衡量对临终护理质量或死亡及濒死体验的影响。所有研究都存在一定的偏倚风险，在牛津质量量表上大多得分较低。虽然ACP干预措施受到老年人的欢迎，并且总体上对结局有积极影响，但本评价强调需要精心设计的RCT来考察ACP的经济影响及其对养老院和其他部门护理质量的影响。
