Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
BMC Geriatr. 2019 Aug 5;19(1):212. doi: 10.1186/s12877-019-1211-2.
Despite the perceived ethical, personal and health service benefits of advance care planning (ACP), the extent to which older and seriously ill Australian inpatients have considered future health decisions remains uncertain. This study aimed to determine in a sample of older and seriously ill inpatients, the proportion who had: 1) engaged in four advance care planning (ACP) activities; 2) not engaged in ACP activities but wanted to; and 3) reasons why they had not engaged.
Cross-sectional face-to-face standardised interview survey with inpatients in a tertiary referral centre who were either: aged 80+ years; aged 55+ years with progressive chronic disease(s); or judged by treating clinicians as having a life expectancy of less than 12 months. Patients indicated whether they had engaged in four ACP activities: (1) appointed medical substitute-decision-maker(s), (2) recorded end-of-life wishes in an advance directive or care plan; and talked about their end-of-life wishes with their: (3) support persons and/or (4) doctors. Patients who had not engaged in activities were asked whether they wished this to occur and reasons why.
One hundred eighty-six inpatients consented to the study (80% of approached). Of these, 9% (n = 16) had engaged in four ACP activities; 27% (n = 50) had not engaged in any. Half (n = 94, 52%) had appointed a medical substitute-decision-maker, 27% (n = 50) had recorded wishes in an advance directive or care plan, 51% (n = 90) had talked about their end-of-life wishes with support persons and 27% (n = 48) had talked with their doctor. Patients who wanted to, but had not, engaged in the four ACP activities were unaware they could record wishes or appoint decision-makers, or indicated providers had not initiated conversations.
Relatively few inpatients had engaged in all four ACP activities. More inpatients had discussed end of life issues with family and appointed substitute decision makers, than completed written documents or talked with doctors. Community education and a more active role for community and hospital-based providers in supporting patients and families to collaboratively resolve end-of-life decisions may increase the probability wishes are known and followed.
尽管预先医疗护理计划（ACP）在伦理、个人和卫生服务方面具有明显的益处，但在多大程度上，澳大利亚的老年和重病住院患者已经考虑了未来的健康决策仍然不确定。本研究旨在确定在一个老年和重病住院患者样本中，有以下情况的患者比例：1）参与了四项 ACP 活动；2）未参与 ACP 活动但希望参与；3）他们没有参与的原因。
在一家三级转诊中心，对年龄在 80 岁以上的患者；年龄在 55 岁以上患有进行性慢性疾病的患者；或由治疗医生判断预期寿命不足 12 个月的患者，进行横断面面对面的标准访谈调查。患者表明他们是否参与了四项 ACP 活动：1）指定医疗替代决策人；2）在预先指示或护理计划中记录临终意愿；并与他们的：3）支持人员和/或 4）医生讨论他们的临终意愿。未参与活动的患者被问及是否希望参与以及原因。
186 名住院患者同意参与研究（占被邀请患者的 80%）。其中，9%（n=16）参与了四项 ACP 活动；27%（n=50）未参与任何活动。一半（n=94，52%）已指定医疗替代决策人，27%（n=50）已在预先指示或护理计划中记录了意愿，51%（n=90）已与支持人员讨论了他们的临终意愿，27%（n=48）已与医生讨论过。想要但尚未参与四项 ACP 活动的患者表示，他们不知道可以记录意愿或指定决策人，或者表示提供者没有发起对话。
相对较少的住院患者参与了所有四项 ACP 活动。与完成书面文件或与医生交谈相比，更多的住院患者与家人讨论了生命末期问题，并指定了替代决策人。为了增加意愿被知晓和遵循的可能性，可能需要对社区进行教育，并由社区和医院的提供者在支持患者和家庭共同解决生命末期决策方面发挥更积极的作用。
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