在有姑息治疗需求的患者中开展医院主导、非促进者协助的预先医疗指示文件记录的可行性。
Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs.
机构信息
Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands.
Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands.
出版信息
BMC Palliat Care. 2018 May 24;17(1):79. doi: 10.1186/s12904-018-0331-3.
BACKGROUND
Advance Care Planning (ACP) and its documentation, accessible to healthcare professionals regardless of where patients are staying, can improve palliative care. ACP is usually performed by trained facilitators. However, ACP conversations would be more tailored to a patient's specific situation if held by a patient's clinical healthcare team. This study assesses the feasibility of ACP by a patient's clinical healthcare team, and analyses the documented information including current and future problems within the palliative care domains.
METHODS
This multicentre study was conducted at the three Groningen Palliative Care Network hospitals in the Netherlands. Patients discharged from hospital with a terminal care indication received an ACP document from clinical staff (non-palliative care trained staff at hospitals I and II; specialist palliative care nurses at hospital III) after they had held ACP conversations. An anonymised copy of this ACP document was analysed. Documentation rates of patient and contact details were investigated, and documentation of current and future problems were analysed both quantitatively and qualitatively.
RESULTS
One hundred sixty ACP documents were received between April 2013 and December 2014, with numbers increasing for each consecutive 3-month time period. Advance directives were frequently documented (82%). Documentation rates of current problems in the social (24%), psychological (27%) and spiritual (16%) domains were low compared to physical problems (85%) at hospital I and II, but consistently high (> 85%) at hospital III. Of 545 documented anticipated problems, 92% were physical or care related in nature, 2% social, 5% psychological, and < 1% spiritual. Half of the anticipated non-physical problems originated from hospital III.
CONCLUSIONS
Hospital-initiated ACP documentation by a patient's clinical healthcare team is feasible: the number of documents received per time period increased throughout the study period, and overall, documentation rates were high. Nonetheless, symptom documentation predominantly regards physical symptoms. With the involvement of specialist palliative care nurses, psychological and spiritual problems are addressed more frequently. Whether palliative care education for non-palliative care experts will improve identification and documentation of non-physical problems remains to be investigated.
背景
无论患者身在何处，都能为医疗保健专业人员提供可及的预先医疗指示（ACP）及其文件，从而改善姑息治疗。ACP 通常由经过培训的促进者进行。然而，如果由患者的临床医疗团队进行 ACP 对话，它将更能针对患者的具体情况进行调整。本研究评估了患者临床医疗团队进行 ACP 的可行性，并分析了文件记录的信息，包括姑息治疗领域内当前和未来的问题。
方法
这项多中心研究在荷兰的三个格罗宁根姑息治疗网络医院进行。从医院出院的具有终末护理指征的患者在进行 ACP 对话后，会收到临床工作人员（I 号和 II 号医院非姑息治疗培训的工作人员；III 号医院的专科姑息治疗护士）提供的 ACP 文件。对这份 ACP 文件的匿名副本进行了分析。调查了患者和联系方式的记录率，并对当前和未来问题的记录进行了定量和定性分析。
结果
2013 年 4 月至 2014 年 12 月期间共收到 160 份 ACP 文件，每连续 3 个月的时间内数量都在增加。经常记录的是预先医疗指示（82%）。与 I 号和 II 号医院的身体问题（85%）相比，社会（24%）、心理（27%）和精神（16%）领域的当前问题记录率较低，但在 III 号医院一直很高（>85%）。在记录的 545 个预期问题中，92%为身体或护理相关问题，2%为社会问题，5%为心理问题，<1%为精神问题。一半的预期非身体问题源自 III 号医院。
结论
由患者的临床医疗团队发起的医院 ACP 文件记录是可行的：在整个研究期间，每个时间段收到的文件数量都在增加，总体记录率很高。尽管如此，症状记录主要还是身体症状。由于专科姑息治疗护士的参与，更频繁地解决了心理和精神问题。姑息治疗专家对非姑息治疗专家的教育是否会改善非身体问题的识别和记录仍有待调查。
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