New York Medical College, Valhalla, New York.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.
J Am Geriatr Soc. 2018 Dec;66(12):2367-2371. doi: 10.1111/jgs.15524. Epub 2018 Oct 22.
To characterize the goals and approaches of clinicians with experience discussing long-term prognostic information with older adults.
We used a semistructured interview guide containing 2 domains of perceived benefits and strategies to explore why and how clinicians choose to discuss long-term prognosis, defined as life expectancy on the scale of years, with patients.
Clinicians from home-based primary care practices, community-based clinics, and academic medical centers across San Francisco.
Fourteen physicians, including 11 geriatricians and 1 geriatric nurse practitioner, with a mean age of 40 and a mean 9 years in practice.
Clinician responses were analyzed qualitatively using the constant comparisons approach.
Perceived benefits of discussing long-term prognosis included establishing realistic expectations for patients, encouraging conversations about future planning, and promoting shared decision-making through understanding of patient goals of care. Communication strategies included adapting discussions to individual patient preferences and engaging in multiple conversations over time. Clinicians preferred to communicate prognosis in words and with a visual aid, although most did not know of a suitable visual aid.
Engaging in customized longitudinal discussions of long-term prognosis aids clinicians in anchoring conversations about future planning and preparing patients for the end of life. J Am Geriatr Soc 66:2367-2371, 2018.
描述具有与老年人讨论长期预后信息经验的临床医生的目标和方法。
我们使用了包含两个感知益处领域和策略的半结构化访谈指南，以探讨临床医生为什么以及如何选择与患者讨论长期预后，即按年计算的预期寿命。
旧金山的家庭基础初级保健诊所、社区诊所和学术医疗中心的临床医生。
14 名医生，包括 11 名老年病医生和 1 名老年执业护士，平均年龄 40 岁，平均从业 9 年。
使用恒定比较法对临床医生的反应进行定性分析。
讨论长期预后的感知益处包括为患者建立现实的期望，鼓励关于未来规划的对话，以及通过了解患者的护理目标来促进共同决策。沟通策略包括根据患者的个人喜好调整讨论，并随着时间的推移进行多次对话。临床医生更喜欢用言语和视觉辅助工具来传达预后，尽管大多数人都不知道合适的视觉辅助工具。
进行个性化的长期预后纵向讨论有助于临床医生围绕未来规划进行对话，并为患者的生命终期做好准备。
J Am Geriatr Soc 66:2367-2371, 2018.
