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从居民、家庭和临床医生的角度描述预备性预先医疗指令的准备情况:支持性生活中的解释性描述性研究。

Characterizing Readiness for Advance Care Planning From the Perspective of Residents, Families, and Clinicians: An Interpretive Descriptive Study in Supportive Living.

机构信息

Community Health Science/Cumming School of Medicine, University of Calgary, Alberta, Canada.

Faculty of Social Work, University of Calgary, Alberta, Canada.

出版信息

Gerontologist. 2018 Jul 13;58(4):739-748. doi: 10.1093/geront/gnx006.

Abstract

BACKGROUND AND OBJECTIVES

Advance care planning (ACP) involves reflection on health care preferences and communication of the person's wishes in case of future incapacity. ACP is particularly pertinent in supportive living (SL) as residents are at high risk of cognitive decline and changes in health status, but the readiness of residents, families, and health care practitioners to engage in ACP discussions is not known. The purpose of this study was to explore the readiness among these stakeholders and the factors that influence the degree of readiness.

RESEARCH DESIGN AND METHODS

Twenty-seven participants (10 residents, 8 family members, 9 health care practitioners) affiliated with 4 SL facilities in Calgary, AB, Canada took part in semistructured, one-on-one interviews. An interpretive descriptive approach was utilized to generate clinically relevant findings.

RESULTS

Variability in the conceptualization of ACP, including confusion regarding terminology, emerged as a major theme. Themes that influenced readiness for engagement in ACP discussions included the influence of prior experience for residents and family members, perception of treatment goals, and understanding of roles in the process between the groups.

DISCUSSION AND IMPLICATIONS

Recommendations for clinicians include clarifying ACP concepts for themselves and residents, shifting focus toward an elucidation of values and preferences rather than on documentation, greater clarity about the roles of the various stakeholders, and recognizing the importance of prior experience for residents and family members. These findings can be used to contribute to the understanding of ACP engagement in SL and inform an approach to engaging in meaningful discussions about ACP.

摘要

背景与目的

预先医疗照护计划(ACP)涉及对医疗偏好的反思,以及在未来丧失能力时传达个人意愿。ACP 在支援性居住(SL)中尤为重要,因为居民有认知能力下降和健康状况变化的高风险,但居民、家属和医疗保健从业者准备进行 ACP 讨论的程度尚不清楚。本研究的目的是探讨这些利益相关者的准备情况,以及影响准备程度的因素。

研究设计与方法

来自加拿大阿尔伯塔省卡尔加里市的 4 家 SL 设施的 27 名参与者(10 名居民、8 名家属、9 名医疗保健从业者)参加了半结构化的一对一访谈。采用解释性描述方法得出具有临床相关性的发现。

结果

ACP 的概念存在差异,包括术语混淆,这是一个主要主题。影响参与 ACP 讨论准备程度的主题包括居民和家属的先前经验的影响、对治疗目标的看法以及对各群体之间过程中角色的理解。

讨论与意义

对临床医生的建议包括为自己和居民澄清 ACP 概念,将重点从文件记录转移到阐明价值观和偏好,更清楚地界定各利益相关者的角色,并认识到居民和家属先前经验的重要性。这些发现可用于帮助理解 SL 中的 ACP 参与,并为进行有意义的 ACP 讨论提供方法。

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