McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada.
Health Sciences Centre, McMaster University School of Nursing, 2J20, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
BMC Palliat Care. 2020 Nov 26;19(1):179. doi: 10.1186/s12904-020-00689-9.
Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC.
A combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims.
Focus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%).
ACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.
尽管已经认识到了advance care planning（ACP，预立医疗照护计划）的好处，但它在长期护理（long-term care，LTC）中通常并不是一个组成部分。已经开发了一系列工具和工作手册来支持一般人群的 ACP 采用。然而，它们在改善 LTC 中的 ACP 采用方面的潜力尚未得到检验。本研究通过以下方式来探讨现有的 ACP 工具是否可用于 LTC：（a）征求工作人员对支持 LTC 中 ACP 工具可用性的内容和格式的意见；（b）检查公共可用的 ACP 工具是否包含 LTC 家庭工作人员认为相关的内容。最终，本研究旨在确定现有 ACP 工具提高 LTC 中 ACP 参与度的潜力。
使用焦点小组讨论和对公共可用的 ACP 工具的内容分析（n=32）相结合的方法来实现研究目的。
焦点小组讨论表明，如果工具包括心理社会因素并且存在基于纸张的版本，那么公共可用的 ACP 工具可能可用于 LTC。对现有基于纸张的工具的内容分析表明，只有少数 ACP 工具（32/611，5%）包含心理社会内容，其中大多数鼓励心理社会导向的思考（30/32，84%），而很少有工具提供关于 ACP 的其他元素的指导，例如传达心理社会偏好（14/32，44%）或将偏好转化为书面计划（7/32，22%）。
包含心理社会内容的 ACP 工具可能会提高 LTC 中的 ACP 采用率，因为它们引出了被认为相关的未来护理问题，并且可以得到各种临床和非临床工作人员的支持。为了提高可用性和参与度，ACP 工具可能需要注入与体弱老年人相关的情景，并且在引发思考的心理社会内容和支持沟通的心理社会内容之间取得更好的平衡。
