From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB)
J Am Board Fam Med. 2021 Jan-Feb;34(1):171-180. doi: 10.3122/jabfm.2021.01.200184.
Group visits have the potential to help patients identify their health care values and engage in the emotionally and cognitively challenging task of advance care planning (ACP) in a resource-efficient manner by providing a forum for social learning and social support.
To evaluate the feasibility and acceptability of disease-specific group visits for patients with heart failure and their caregivers.
Feasibility trial of a 90-minute group visit held for 10 separate groups and led by a trained facilitator using the video-based PREPARE for Your Care ACP tool.
SETTING/SUBJECTS: Older adults with recent hospitalization for heart failure (n = 36; median age, 74 years) and their caregivers (n = 21).
Pre- and post-visit surveys and a postvisit telephone interview assessing perceived value and acceptability; structured nonparticipant observations to assess process and feasibility.
Mean scores from the postgroup visit evaluation showed that participants reported that they felt comfortable discussing ACP in a group (4.59), understood the information covered (4.70), and were able to identify and clarify their health care values (4.43). Interview and observation data demonstrated that participants were able to identify and clarify their preferences by listening and learning from a diverse range of perspectives in the group and that the disease-focused nature of the group visit created a supportive space for participants to share their experiences.
Disease-focused ACP group visits were feasible to conduct and acceptable to participants, underscoring their value as an efficient intervention to engage patients and caregivers in the otherwise time- and resource-intensive task of ACP.
小组访问有潜力通过提供社会学习和社会支持的论坛，帮助患者确定其医疗保健价值观，并以资源高效的方式参与到预先医疗照护计划（ACP）这一具有挑战性的情感和认知任务中。
评估针对心力衰竭患者及其照护者的特定疾病小组访问的可行性和可接受性。
使用基于视频的 PREPARE for Your Care ACP 工具，由经过培训的主持人为 10 个独立小组进行的 90 分钟小组访问的可行性试验。
设置/受试者：最近因心力衰竭住院的老年患者（n=36；中位数年龄，74 岁）及其照护者（n=21）。
在访问前后进行调查和电话访问，以评估感知价值和可接受性；进行非参与式结构观察，以评估过程和可行性。
小组访问后评估的平均得分表明，参与者报告说他们在小组中讨论 ACP 感到舒适（4.59），理解所涵盖的信息（4.70），并且能够识别和阐明他们的医疗保健价值观（4.43）。访谈和观察数据表明，参与者能够通过倾听和从小组中不同的观点中学习来识别和阐明自己的偏好，并且小组访问的疾病重点性质为参与者提供了一个支持性的空间，让他们分享自己的经验。
针对特定疾病的 ACP 小组访问是可行且可接受的，这突出了它们作为一种高效干预措施的价值，可使患者和照护者参与到原本时间和资源密集型的 ACP 任务中。
