Vanderhaeghen Birgit, Bossuyt Inge, Menten Johan, Rober Peter
Palliative Support Team, University Hospitals Leuven, Leuven, Belgium.
Department of Radiation-Oncology and Palliative Care, University Hospitals Leuven, Leuven, Belgium.
J Palliat Care. 2020 Oct;35(4):236-242. doi: 10.1177/0825859720938583. Epub 2020 Jul 8.
Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies.
For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning.
Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis.
Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy.
This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.
比利时医院实践中预先护理计划的实施情况不佳。为了实现成功实施，实施理论表明采用者应参与实施过程。这些信息可为制定更好的实施策略提供依据。
在本研究中，我们询问了住院的姑息治疗患者及其家属，他们认为良好的预先护理计划是什么样的。
按照埃利奥特的磁带辅助回忆程序，对患者及其家属进行了29次访谈。这些访谈采用基于扎根理论的内容分析法进行分析。为提高可靠性，由3名独立的外部审核员对分析进行审核。
结果表明，住院的姑息治疗患者及其家属希望在整个疾病过程中就治疗和护理进行预先护理计划沟通，涉及不同方面：社会、心理、身体、实际和医疗。他们更愿意与主管医生进行这些对话。他们报告了预先护理计划沟通的4个重要目标：与医生建立信任关系，在这种关系中他们感受到医生的参与；为决策过程提供和接收相关信息，就首选的治疗和护理做出个人决定；在医生、患者和家属关于治疗和护理政策的首选决定之间达成共识。
本研究有助于在医院实践中实施预先护理计划，因为它深入了解了患者和家属认为预先护理计划中的哪些要素是必要的，以及何时预先护理计划对他们来说是必要的。
