Glaudemans Jolien J, de Jong Anja E, Onwuteaka Philipsen Bregje D, Wind Jan, Willems Dick L
Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, the Netherlands.
Department of public and occupational health, Amsterdam Public Health Research Institute Expertise Centre for Palliative Care, VU Medical Centre, the Netherlands.
Fam Pract. 2019 Mar 20;36(2):219-224. doi: 10.1093/fampra/cmy055.
Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers.
To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers.
A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed.
We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP.
Primary care professionals can overcome barriers to ACP with older patients by practicing, reflecting on experiences and pursuing continuing education, by preparing patients and involving family and by investing in support to approach ACP more efficiently.
由于与初级保健专业人员相关的若干障碍，如知识不足、消极观念和时间短缺，很少有老年人能从预先护理计划（ACP）中受益。关于克服这些障碍的信息有限。我们认为，在ACP方面有经验的初级保健专业人员可能已经学会如何克服这些障碍。
调查在ACP方面有经验的荷兰初级保健专业人员如何克服这些障碍。
基于半结构化访谈进行定性研究，对象为14名在ACP方面有经验的荷兰初级保健专业人员，这些人员是经过有目的抽样选取的。对访谈记录进行主题分析。
我们采访了8名全科医生（GP）、3名护士和3名老年护理医生，他们在ACP方面有经验。受访者通过在日常实践中开展ACP积累经验、与同行交流和反思这些经验、参加继续教育、教学和参与研究，克服了自身知识和技能不足以及消极态度和观念。为克服患者及其家属对ACP缺乏主动性和开放性的问题，受访者让他们为ACP的后续步骤做好准备。为克服时间短缺问题，受访者使用工具和信息通信技术，将ACP的部分工作委托给其他初级保健专业人员，获取资金并使ACP的文档系统化。
初级保健专业人员可以通过实践、反思经验和参加继续教育，通过让患者做好准备并让家属参与，以及通过投入支持以更高效地开展ACP，来克服与老年患者进行ACP时遇到的障碍。
