Williams Molly T, Kozachik Sharon L, Karlekar Mohana, Wright Rebecca
Johns Hopkins University, School of Nursing, Baltimore, MD, USA.
Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Hosp Palliat Care. 2020 Nov;37(11):950-956. doi: 10.1177/1049909120909518. Epub 2020 Mar 13.
Advance care planning (ACP) discussions help guide future medical care consistent with patient wishes. These discussions should be a part of routine care and should be readdressed frequently as a patient's medical condition changes. Limited literature exists supporting structured processes for identifying persons who may benefit from these conversations. The purpose of this integrative review was to understand whether targeting patients with episodic disease trajectories in the acute care setting will increase their willingness to participate in ACP discussions.
Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query "In the acute care setting, does targeting patients with heart failure or chronic obstructive pulmonary disease for ACP lead to increased willingness to participate in these discussions." Articles from 2009 to September 2019 were considered for review.
Six articles met inclusion criteria for final analysis. Articles outside of the United States were excluded. Four themes emerged from the literature: (1) improved patient attitudes toward ACP, (2) effective communication surrounding care preferences, (3) strengthened connection between preferred and delivered care, and (4) increased patient involvement in ACP.
Chronic diseases such as heart failure and COPD have a high symptom burden punctuated by exacerbations, making it difficult to know when introduction of ACP discussions would be most beneficial. Future research should focus on a deeper evaluation of when to introduce ACP conversations in this population and which ACP interventions are effective to facilitate these discussions.
预先护理计划（ACP）讨论有助于根据患者意愿指导未来的医疗护理。这些讨论应成为常规护理的一部分，并应随着患者病情的变化经常重新进行。支持确定可能从这些对话中受益的人员的结构化流程的文献有限。本整合性综述的目的是了解在急性护理环境中针对患有发作性疾病轨迹的患者是否会增加他们参与ACP讨论的意愿。
以约翰霍普金斯循证护理实践模型为指导方针，本整合性综述聚焦于研究问题“在急性护理环境中，针对心力衰竭或慢性阻塞性肺疾病患者进行ACP是否会导致他们参与这些讨论的意愿增加”。纳入2009年至2019年9月的文章进行综述。
六篇文章符合最终分析的纳入标准。排除美国以外的文章。文献中出现了四个主题：（1）患者对ACP的态度改善；（2）围绕护理偏好的有效沟通；（3）偏好护理与实际提供护理之间的联系加强；（4）患者对ACP的参与增加。
心力衰竭和慢性阻塞性肺疾病等慢性疾病症状负担重，且有病情加重情况，因此很难确定何时引入ACP讨论最为有益。未来的研究应侧重于更深入地评估何时在此人群中引入ACP对话，以及哪些ACP干预措施有助于促进这些讨论。
