General Practice & Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
BMC Palliat Care. 2020 Mar 6;19(1):27. doi: 10.1186/s12904-020-0535-1.
Since the introduction of the concept of advance care planning (ACP), many studies have been conducted exploring beneficial effects. These studies show a heterogeneity in clinical endpoints, which reflects diversity of goals connected to ACP. This study aims to get insight in the range of underlying goals that comprise the legitimacy of ACP.
Systematic literature search in PubMed, EMBASE, PsychInfo, CINAHL and Cochrane Library. Articles on normative aspects of ACP were included, based on title and abstract. Due to the quantity of inclusions, of which many had similar content, purposive sampling was used to select articles for full text document analysis. Analysis stopped once saturation was reached.
In total, 6497 unique articles were found of which 183 were included. Saturation was reached after document analysis of 55 articles (30%); this yielded 141 codes concerning goals of ACP and also 70 codes about objections against ACP, which shed light on the underlying goals of ACP as well. We identified five underlying goals: respecting individual patient autonomy, improving quality of care, strengthening relationships, preparing for end-of-life, reducing overtreatment.
Five distinctive underlying goals of ACP were identified, each with corresponding objections that need to be considered. Specifying underlying goals of ACP may direct the debate on definitions, methods and preferred outcomes of ACP. This study was funded by the Netherlands Organisation for Health Research and Development, grant 839120002.
自提出预先医疗照护计划（ACP）的概念以来，已有许多研究探索其有益效果。这些研究表明，临床终点存在异质性，这反映了与 ACP 相关的目标多样性。本研究旨在深入了解构成 ACP 合理性的潜在目标范围。
在 PubMed、EMBASE、PsychInfo、CINAHL 和 Cochrane Library 中进行系统文献检索。根据标题和摘要纳入关于 ACP 规范性方面的文章。由于纳入的文章数量众多，其中许多内容相似，因此采用目的性抽样选择全文文档分析的文章。一旦达到饱和，分析就停止。
总共发现了 6497 篇独特的文章，其中 183 篇被纳入。对 55 篇文章（30%）进行全文文档分析后达到饱和，这产生了 141 个关于 ACP 目标的代码，以及 70 个关于反对 ACP 的代码，这也揭示了 ACP 的潜在目标。我们确定了五个潜在目标：尊重个体患者自主权、提高护理质量、加强关系、为临终做准备、减少过度治疗。
确定了 ACP 的五个独特的潜在目标，每个目标都有相应的反对意见需要考虑。明确 ACP 的潜在目标可以指导关于 ACP 的定义、方法和首选结果的辩论。本研究由荷兰健康研究与发展组织资助，拨款 839120002。
