Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada.
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.
BMC Palliat Care. 2020 Oct 1;19(1):150. doi: 10.1186/s12904-020-00655-5.
Advance care planning (ACP) is a process by which patients reflect upon their goals, values and beliefs to allow them to make decisions about their future medical treatment that align with their goals and values, improving patient-centered care. Despite this, ACP is underutilized and is reported as one of the most difficult processes of oncology. We sought to: 1) explore patients' and families' understanding, experience and reflections on ACP, as well as what they need from their physicians during the process; 2) explore physicians' views of ACP, including their experiences with initiating ACP and views on ACP training.
This was a qualitative descriptive study in Nova Scotia, Canada with oncologists, advanced cancer out-patients and their family members. Semi-structured interviews with advanced cancer out-patients and their family members (n = 4 patients, 4 family members) and oncologists (n = 10) were conducted; each participant was recruited separately. Data were analyzed using constant comparative analysis, which entailed coding, categorizing, and identifying themes recurrent across the datasets.
Themes were identified from the patient / family and oncologist groups, four and five respectively. Themes from patients / families included: 1) positive attitudes towards ACP; 2) healthcare professionals (HCPs) lack an understanding of patients' and families' informational needs during the ACP process; 3) limited access to services and supports; and 4) poor communication between HCPs. Themes from oncologists included: 1) initiation of ACP discussions; 2) navigating patient-family dynamics; 3) limited formal training in ACP; 4) ACP requires a team approach; and 5) lack of coordinated systems hinders ACP.
Stakeholders believe ACP for advanced cancer patients is important. Patients and families desire earlier and more in-depth discussion of ACP, additional services and supports, and improved communication between their HCPs. In the absence of formal training or guidance, oncologists have used clinical acumen to initiate ACP and a collaborative healthcare team approach.
预先医疗照护计划（ACP）是一个让患者反思自己的目标、价值观和信念的过程，使他们能够根据自己的目标和价值观做出未来医疗治疗的决策，从而改善以患者为中心的护理。尽管如此，ACP 的利用率仍然很低，并且被报告为肿瘤学中最困难的过程之一。我们试图：1）探讨患者和家属对 ACP 的理解、经验和反思，以及他们在这一过程中需要医生提供什么；2）探讨医生对 ACP 的看法，包括他们在启动 ACP 方面的经验以及对 ACP 培训的看法。
这是加拿大新斯科舍省的一项定性描述性研究，涉及肿瘤学家、晚期癌症门诊患者及其家属。对晚期癌症门诊患者及其家属（n=4 名患者，4 名家属）和肿瘤学家（n=10）进行了半结构化访谈；每个参与者都是单独招募的。使用恒比分析方法对数据进行分析，该方法包括编码、分类和识别跨数据集重复出现的主题。
从患者/家属和肿瘤学家两组中分别确定了主题，分别为四个和五个。患者/家属组的主题包括：1）对 ACP 的积极态度；2）医疗保健专业人员（HCPs）在 ACP 过程中缺乏对患者和家属信息需求的了解；3）服务和支持的有限获取；4）HCPs 之间沟通不畅。肿瘤学家组的主题包括：1）启动 ACP 讨论；2）驾驭患者-家庭动态；3）在 ACP 方面的正式培训有限；4）ACP 需要团队方法；5）缺乏协调的系统阻碍了 ACP。
利益相关者认为晚期癌症患者的 ACP 很重要。患者和家属希望更早、更深入地讨论 ACP，增加服务和支持，并改善他们与 HCPs 之间的沟通。在缺乏正式培训或指导的情况下，肿瘤学家使用临床敏锐度来启动 ACP，并采用协作的医疗团队方法。
