Frechman Erica, Dietrich Mary S, Walden Rachel Lane, Maxwell Cathy A
Vanderbilt University School of Nursing, Nashville, Tennessee, USA.
Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee, USA.
J Pain Symptom Manage. 2020 Dec;60(6):1208-1222.e59. doi: 10.1016/j.jpainsymman.2020.06.043. Epub 2020 Jul 6.
Advance care planning (ACP) is essential to elicit goals, values, and preferences of care in older adults with serious illness and on trajectories of frailty. An exploration of ACP uptake in older adults may identify barriers and facilitators.
To conduct an integrative review of research on the uptake of ACP in older adults and create a conceptual model of the findings.
Using Whittemore and Knafl's methodology, we systematically searched four electronic databases of ACP literature in older adults from 1996 through December 2019. Critical appraisal tools were used to assess study quality, and articles were categorized according to level of evidence. Statistical and thematic analysis was then undertaken.
Among 1081 studies, 78 met inclusion criteria. Statistical analysis evaluated ACP and variables within the domains of demographics, psychosocial, disability and functioning, and miscellaneous. Thematic analysis identified a central category of enhanced communication, followed by categories of 1) provider role and preparation; 2) patient/family relationship patterns; 3) standardized processes and structured approaches; 4) contextual influences; and 5) missed opportunities. A conceptual model depicted categories and relationships.
Enhanced communication and ACP facilitators improve uptake of ACP. Clinicians should be cognizant of these factors. This review provides a guide for clinicians who are considering implementation strategies to facilitate ACP in real-world settings.
预先护理计划（ACP）对于了解患有严重疾病和处于虚弱轨迹的老年人的护理目标、价值观和偏好至关重要。探索老年人对ACP的接受情况可能会发现障碍和促进因素。
对有关老年人对ACP接受情况的研究进行综合综述，并建立研究结果的概念模型。
采用惠特莫尔和克纳夫的方法，我们系统检索了1996年至2019年12月期间四个关于老年人ACP文献的电子数据库。使用批判性评估工具评估研究质量，并根据证据水平对文章进行分类。然后进行统计和主题分析。
在1081项研究中，78项符合纳入标准。统计分析评估了ACP以及人口统计学、心理社会、残疾和功能以及其他领域内的变量。主题分析确定了一个核心类别即加强沟通，其次是以下类别：1）提供者的角色和准备；2）患者/家庭关系模式；3）标准化流程和结构化方法；4）背景影响；5）错失的机会。一个概念模型描绘了这些类别及其关系。
加强沟通和ACP促进因素可提高对ACP的接受度。临床医生应认识到这些因素。本综述为考虑在现实环境中促进ACP实施策略的临床医生提供了指导。
