通过养老院中的预先护理计划提高患者参与度-一项集群随机临床试验。
Improved patient participation through advance care planning in nursing homes-A cluster randomized clinical trial.
机构信息
Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway; Department of Health Sciences, University of Oslo, Forskningsveien 3A Harald Schjelderups hus, 0373, Oslo, Norway.
出版信息
Patient Educ Couns. 2019 Dec;102(12):2183-2191. doi: 10.1016/j.pec.2019.06.001. Epub 2019 Jun 6.
OBJECTIVE
To improve patient participation in advance care planning in nursing homes where most patients have some degree of cognitive impairment.
METHODS
This was a pair-matched cluster randomized clinical trial with eight wards in eight Norwegian nursing homes. We randomized one ward from each of the matched pairs to the intervention group. We included all patients above 70. The primary outcome was prevalence of documented patient participation in end-of-life treatment conversations. The intervention included implementation support using a whole-ward approach where regular staff perform advance care planning and invite all patients and next of kin to participate.
RESULTS
In intervention group wards the patients participated more often in end-of-life treatment conversations (p < 0.001). Moreover, the patient's preferences, hopes AND worries (p = 0,006) were more often documented, and concordance between provided TREATMENT and patient preferences (p = 0,037) and next of kin participation in advance care planning with the patient (p = 0,056) increased.
CONCLUSION
Improved patient participation - also when cognitively impaired - is achievable through advance care planning in nursing homes using a whole-ward approach.
PRACTICE IMPLICATIONS
Patients with cognitive impairment should be included in advance care planning supported by next of kin. A whole-ward approach may be used to implement advance care planning.
TRIAL REGISTRATION
ISRCTN registry (ID ISRCTN69571462) - retrospectively registered.
目的
提高养老院中患者参与预先医疗指示的程度，因为这些患者大多存在一定程度的认知障碍。
方法
这是一项配对的集群随机临床试验，涉及挪威 8 家养老院的 8 个病房。我们将每个配对中的一个病房随机分配到干预组。纳入标准为 70 岁以上的患者。主要结局是记录患者参与临终治疗对话的比例。干预措施包括使用全病房方法提供实施支持，其中定期工作人员进行预先医疗指示，并邀请所有患者及其家属参与。
结果
在干预组病房，患者更频繁地参与临终治疗对话（p<0.001）。此外，患者的偏好、希望和担忧（p=0.006）更常被记录，提供的治疗与患者偏好的一致性（p=0.037）以及家属参与患者预先医疗指示的程度（p=0.056）增加。
结论
通过在养老院中使用全病房方法进行预先医疗指示，可以提高患者的参与度，即使患者存在认知障碍。
实践意义
应包括认知障碍患者在内的预先医疗指示，由家属提供支持。全病房方法可用于实施预先医疗指示。
试验注册
ISRCTN 注册（注册号 ISRCTN69571462）- 回溯性注册。
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