School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
NHS Tayside and Dundee Health and Social Care Partnership, Dundee, UK.
Eur Geriatr Med. 2020 Jun;11(3):353-368. doi: 10.1007/s41999-020-00314-1. Epub 2020 Apr 2.
To identify and assess factors that affect the decisions to initiate advance care planning (ACP) amongst people living with dementia (PwD).
A narrative review was conducted. A keyword search of Medline, CINAHL PsycINFO, and Web of Sciences databases produced 22,234 articles. Four reviewers independently applying inclusion/exclusion criteria resulted in 39 articles. Discrepancies were settled in discussion.
Twenty-eight primary studies and eleven review articles remained. Narrative analysis generated five categories of facilitating and inhibitory factors: people with dementia, family orientation, healthcare professionals (HCP), systemic and contextual factors, and time factors. Key facilitators of ACP initiation were (i) healthcare settings with supportive policies and guidelines, (ii) family members and HCPs who have a supportive relationship with PwD, and (iii) HCPs who received ACP education. Key inhibitors were: (i) lack of knowledge about the dementia trajectory in stakeholders, (ii) lack of ACP knowledge, and (iii) unclear timing to initiate an ACP.
This review highlighted the main challenges associated with optimal ACP initiation with PwD. To encourage effective ACP initiation with PwD, succinct policies and guidelines for clinical commissioners are needed. ACP also needs to be discussed with family members in an informal, iterative manner. More research is required on initiation timing given the disease trajectory and changing family dynamics.
确定并评估影响痴呆症患者（PwD）启动预先护理计划（ACP）的因素。
进行了叙述性综述。对 Medline、CINAHL PsycINFO 和 Web of Sciences 数据库进行了关键字搜索，共产生了 22234 篇文章。四名评审员独立应用纳入/排除标准后，有 39 篇文章入选。有分歧的地方通过讨论解决。
保留了 28 项主要研究和 11 项综述文章。叙述性分析产生了五个类别的促进和抑制因素：痴呆症患者、家庭取向、医疗保健专业人员（HCP）、系统和背景因素以及时间因素。ACP 启动的主要促进因素是：（i）有支持性政策和指南的医疗保健环境；（ii）与 PwD 有支持性关系的家庭成员和 HCP；以及（iii）接受 ACP 教育的 HCP。主要的抑制因素包括：（i）利益相关者对痴呆症轨迹的知识不足；（ii）缺乏 ACP 知识；以及（iii）启动 ACP 的时机不明确。
本综述强调了与 PwD 最佳 ACP 启动相关的主要挑战。为了鼓励与 PwD 有效启动 ACP，临床专员需要简洁的政策和指南。还需要以非正式、迭代的方式与家庭成员讨论 ACP。鉴于疾病轨迹和不断变化的家庭动态，需要进一步研究启动时机。
