Nagelschmidt Katharina, Leppin Nico, Seifart Carola, Rief Winfried, von Blanckenburg Pia
Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg.
Ethikkommission Humanmedizin, Philipps-Universität Marburg.
Psychother Psychosom Med Psychol. 2021 May;71(5):192-201. doi: 10.1055/a-1275-0915. Epub 2020 Nov 27.
Early conversations about the end of life can contribute to patient-centered care at the end of life. Too often, however, these conversations do not take place or if they do, they are too late. The aim of this qualitative research was to identify the prerequisites, difficulties and usefulness of such conversations from the point of view of healthy older adults. The findings might be of use in primary health care to provide early and open end-of-life discussions.
The interviews stem from an experimental study concerning the readiness of end-of-life conversations with healthy adults. Six transcripts (2 male and 4 female participants, 65-78 years) were evaluated by using the thematic analysis by Braun and Clarke.
Conditions for the initiation of conversations were thematically separated into beliefs and attitudes, intrinsic motivation, experience, family communication and practical realization. Difficulties were found in the areas of cognitive barriers, practical realization, emotional barriers, relational factors and environmental conditions. Participants saw the usefulness of such conversations in the areas of relationship quality, organizational profit, values, as well as cognitive and emotional areas.
The results are in agreement with past research. From the perspective of older healthy people, family conversations about the end of life can be "too late". However, it also appears that there are specific barriers to early discussions. The findings on helpful conditions and barriers can be used for the development of interventions to increase readiness for such discussions.
Early conversations about the end of life should be offered in the sense of preventive care in a low-threshold way. Providers of primary health care can identify a "need to talk", reduce communication barriers and encourage confrontation with one's own mortality. Adequate information should be provided if necessary, and a structured communication approach should be employed.
关于生命末期的早期对话有助于实现以患者为中心的临终关怀。然而，这类对话常常没有进行，或者即便进行了，也为时已晚。这项定性研究的目的是从健康老年人的角度确定此类对话的先决条件、困难和益处。这些研究结果可能有助于初级卫生保健领域开展早期且开放的临终讨论。
这些访谈源自一项关于与健康成年人进行临终对话意愿的实验研究。采用布劳恩和克拉克的主题分析法对六份访谈记录（2名男性和4名女性参与者，年龄在65 - 78岁之间）进行了评估。
启动对话的条件在主题上分为信念与态度、内在动机、经历、家庭沟通和实际落实。在认知障碍、实际落实、情感障碍、关系因素和环境条件等方面发现了困难。参与者认为此类对话在关系质量、机构收益、价值观以及认知和情感等方面具有益处。
研究结果与过去的研究一致。从健康老年人的角度来看，关于生命末期的家庭对话可能“为时已晚”。然而，早期讨论似乎也存在特定障碍。关于有益条件和障碍的研究结果可用于开发干预措施，以提高人们进行此类讨论的意愿。
应从预防保健的角度以低门槛的方式开展关于生命末期的早期对话。初级卫生保健提供者可以识别出“谈话需求”，减少沟通障碍，并鼓励人们直面自身的死亡。如有必要，应提供充分的信息，并采用结构化的沟通方法。
