Heyland Daren K
Department of Critical Care Medicine, Queen's University, Kingston, ON K7L 2V7, Canada.
Clinical Evaluation Research Unit, Kingston Health Science Centre, Kingston, ON K7L 2V7, Canada.
Healthcare (Basel). 2020 Jul 18;8(3):218. doi: 10.3390/healthcare8030218.
COVID-19 has highlighted the reality of an impending serious illness for many, particularly for older persons. Those faced with severe COVID-19 infection or other serious illness will be faced with decisions regarding admission to intensive care and use of mechanical ventilation. Past research has documented substantial medical errors regarding the use or non-use of life-sustaining treatments in older persons. While some experts advocate that advance care planning may be a solution to the problem, I argue that the prevailing understanding and current practice of advance care planning perpetuates the problem and results in patients not receiving optimal patient-centered care. Much of the problem centers on the framing of advance care planning around end of life care, the lack of use of decision support tools, and inadequate language that does not support shared decision-making. I posit that a new approach and new terminology is needed. Advance Serious Illness Preparations and Planning (ASIPP) consists of discrete steps using evidence-based tools to prepare people for future clinical decision-making in the context of shared decision-making and informed consent. Existing tools to support this approach have been developed and validated. Further dissemination of these tools is warranted.
新冠疫情凸显了许多人，尤其是老年人即将面临严重疾病这一现实。那些面临新冠重症感染或其他严重疾病的人将面临关于入住重症监护室和使用机械通气的决策。过去的研究记录了在老年人使用或不使用维持生命治疗方面存在大量医疗失误。虽然一些专家主张预先护理计划可能是解决该问题的办法，但我认为，目前对预先护理计划的普遍理解和现行做法使问题长期存在，导致患者无法获得以患者为中心的最佳护理。问题的很大一部分集中在围绕临终护理构建预先护理计划、缺乏决策支持工具的使用以及不支持共同决策的语言不充分。我认为需要一种新方法和新术语。严重疾病预先准备和规划（ASIPP）包括使用循证工具的离散步骤，以便在共同决策和知情同意的背景下让人们为未来的临床决策做好准备。支持这种方法的现有工具已经开发并得到验证。有必要进一步推广这些工具。
