Ke Li-Shan, Hu Wen-Yu, Chen Mei-Jung, Cheng Hui-Chuan, Lin Li-Hwa
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Palliat Med. 2020 Mar;23(3):325-336. doi: 10.1089/jpm.2019.0277. Epub 2019 Sep 4.
Surrogates often do not accurately predict older people's preferences about end-of-life (EOL) care. Few studies have examined the impact of advance care planning (ACP) on EOL decision-making consistency between older people and their surrogates, and these studies have yielded conflicting results. To evaluate the effectiveness of ACP in improving EOL decision-making consistency between older people and their surrogates. The intervention in this pre-post quasi-experimental design included an informative video, a brochure about ACP, and a guided discussion about EOL wishes. Two geriatric wards in a medical center in northern Taiwan. One hundred eight participants, as 54 pairs of older people and their surrogates, were randomly assigned to either the experimental or control group. The experimental group received an intervention, while the control group received usual care. Life-Support Preferences Questionnaire. The intervention did not improve decision-making consistency between older people and their surrogates. This was the first time that most pairs discussed specific EOL decisions, so additional preparation may improve comfort with this topic. This study also found that some older people had difficulty concentrating on the educational brochure or understanding the related terms. Preparation for ACP discussion is needed for older people and their surrogates. Longer-term effects of ACP should be monitored because ACP interventions may have enhanced empathy between older people and their surrogates. Additionally, a culturally sensitive illustrated questionnaire that explains life-support preferences and ACP topics may improve communication between older people and their surrogates.
代理人往往无法准确预测老年人对临终关怀的偏好。很少有研究考察过预先护理计划（ACP）对老年人与其代理人之间临终决策一致性的影响，而且这些研究得出了相互矛盾的结果。为了评估ACP在提高老年人与其代理人之间临终决策一致性方面的有效性。在这个前后对照的准实验设计中，干预措施包括一个信息视频、一本关于ACP的宣传册，以及一场关于临终愿望的引导式讨论。台湾北部一家医疗中心的两个老年病房。108名参与者，即54对老年人及其代理人，被随机分配到实验组或对照组。实验组接受干预，而对照组接受常规护理。使用生命支持偏好问卷。该干预措施并未提高老年人与其代理人之间的决策一致性。这是大多数对子首次讨论具体的临终决策，因此额外的准备可能会提高对这个话题的接受度。本研究还发现，一些老年人难以专注于教育宣传册或理解相关术语。需要为老年人及其代理人进行ACP讨论的准备工作。应该监测ACP的长期效果，因为ACP干预可能增强了老年人与其代理人之间的同理心。此外，一份具有文化敏感性的、解释生命支持偏好和ACP主题的图文问卷可能会改善老年人与其代理人之间的沟通。
