Loughborough University, UK.
Loughborough University, UK.
Patient Educ Couns. 2019 Apr;102(4):670-679. doi: 10.1016/j.pec.2018.11.008. Epub 2018 Nov 15.
Giving terminally ill people opportunities to participate in advance care planning involves tensions between: endorsing and supporting patients' expectations, plans and decisions, and addressing how realistic these are. The latter risks exerting undue pressure to change plans; undermining autonomy; jeopardising therapeutic relationships. Our objective is to describe how experienced hospice doctors raise potential/actual problems with patients' expectations, plans or decisions.
Conversation analysis of video-recorded consultations between five UK hospice consultants, 37 patients and their companions.
Eleven episodes involving five doctors were found. In all of these we identified a 'Hypothetical Scenario Sequence' where doctors raise a hypothetical future scenario wherein current plans/expectations turn out to be problematic, then engage patients in discussing what could be done about this. We describe features of this sequence and how it can circumvent the risks of addressing problems with patients' expectations and plans.
Our research breaks new ground, showing that by treating expectations, plans and decisions as potentially not actually problematic, practitioners can recognise and support patients' preferences whilst preparing them for possible difficulties and inevitable uncertainties.
Where professionals judge it appropriate to raise problems about patients' preferences, plans and decisions, this sequence can manage the associated risks.
为绝症患者提供参与预先护理计划的机会涉及到以下几方面的紧张关系：支持和满足患者的期望、计划和决策，并考虑这些期望和决策的现实性。后者可能会带来不必要的压力，改变计划，破坏自主权，危及治疗关系。我们的目的是描述经验丰富的临终关怀医生如何与患者的期望、计划或决策中出现的潜在/实际问题进行交涉。
对五名英国临终关怀顾问、37 名患者及其同伴之间的视频咨询进行会话分析。
共发现 11 个涉及 5 名医生的案例。在所有这些案例中，我们都发现了一个“假设情景序列”，医生提出了一个假设的未来情景，即当前的计划/期望出现问题，然后让患者参与讨论如何解决这个问题。我们描述了这个序列的特征以及它如何规避与患者的期望和计划交涉的风险。
我们的研究开辟了新的领域，表明通过将期望、计划和决策视为潜在而非实际的问题，从业者可以识别和支持患者的偏好，同时为他们可能遇到的困难和不可避免的不确定性做好准备。
在专业人员认为适当的情况下，提出有关患者偏好、计划和决策的问题，该序列可以管理相关风险。
