Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
J Pain Symptom Manage. 2018 Apr;55(4):1105-1112. doi: 10.1016/j.jpainsymman.2017.12.473. Epub 2017 Dec 14.
Little is known about advance care planning (ACP) among community-dwelling patients with dementia.
To describe aspects of ACP among patients with dementia and examine the association between ACP and health care proxy (HCP) acceptance of patients' illness.
Cross-sectional observational survey of 62 HCPs of patients with dementia (N = 14 mild, N = 48 moderate/severe), from seven outpatient geriatric and memory disorder clinics in Boston. Aspects of ACP included HCP's report of patients' preferences for level of future care, communication with HCP and physician regarding care preferences, and proxy preparedness for shared decision making. The association between ACP and HCP acceptance with patients' illness was examined using the Peace, Equanimity, and Acceptance subscale of the Cancer Experience Scale.
Eleven percent of proxies believed that the patient would want life-prolonging treatment, 31% a time-limited trial of curative treatment, and 47% comfort-focused care. Thirty-one percent reported that the patient had communicated with their physician regarding preferences for care, and 77% had communicated with the HCP. Forty-four percent of HCPs wanted more discussion with the patient regarding care preferences. The HCP having discussed care preferences with the patient was associated with greater acceptance of the patient's illness (P = 0.004).
Our findings support need for greater ACP discussions between patients and proxies. Discussions regarding goals of care are likely to benefit patients through delivery of care congruent with their wishes and HCPs in terms of greater acceptance of patients' illness.
社区居住的痴呆症患者的预先医疗照护计划（ACP）知之甚少。
描述痴呆症患者的 ACP 方面，并检查 ACP 与患者健康照护代理人（HCP）接受患者病情之间的关联。
对来自波士顿的七家老年和记忆障碍门诊的 62 名痴呆症患者的 HCP（N=14 名轻度，N=48 名中度/重度）进行横断面观察性调查。ACP 的方面包括 HCP 报告患者对未来护理水平的偏好、与 HCP 和医生就护理偏好进行的沟通，以及代理人对共同决策的准备情况。使用癌症体验量表的和平、平静和接受子量表来检查 ACP 与 HCP 对患者病情的接受程度之间的关联。
11%的代理人认为患者希望接受延长生命的治疗，31%的代理人认为患者希望接受有时间限制的治疗试验，47%的代理人认为患者希望接受以舒适为重点的护理。31%的代理人报告患者与医生讨论过护理偏好，77%的代理人与 HCP 讨论过。44%的 HCP 希望与患者进一步讨论护理偏好。HCP 与患者讨论过护理偏好与患者病情的接受程度更高相关（P=0.004）。
我们的发现支持患者和代理人之间进行更多的 ACP 讨论。讨论护理目标可能会使患者受益，因为可以提供符合他们意愿的护理，并且 HCP 会更接受患者的病情。
