Xi, Assistant Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
Assistant Professor, College of Nursing, Institute for Health Science Research, Inje University, Busan, Republic of Korea.
J Nurs Scholarsh. 2021 Mar;53(2):180-188. doi: 10.1111/jnu.12624. Epub 2021 Jan 21.
Little is known regarding how advance care planning (ACP) interventions change with the progression of dementia. Thus, the primary purpose of this systematic review is to compare characteristics of ACP interventions across dementia stages. We also identify the role of nurses in implementing ACP interventions for persons with dementia and their surrogates.
A systematic review of ACP intervention studies.
After searching PubMed, Web of Science, EMBASE, PsycArticles, the Cumulative Index to Nursing and Allied Health Literture (CINAHL), and Scopus, the final sample included 11 studies representing 10 interventions. We conducted a quality assessment and extracted data on dementia stage, intervention characteristics, and the role of nurses in the intervention. The extracted data were categorized according to stages of dementia, and analyzed to identify commonalities and differences between intervention characteristics.
Three ACP interventions focused on mild dementia and seven on advanced dementia. We observed four primary findings. First, we found a major difference in intervention recipients between the two dementia stages. Second, most ACP interventions included structured discussions regarding the person's life goals and values, goals of care, and preferences concerning future care via individual, face-to-face interactions. Third, ACP interventions designed to promote ongoing discussions and documentation were lacking. Finally, nurses played important roles in implementing ACP interventions.
The findings suggest more nurse-led, dementia-related ACP interventions. In addition, ACP interventions should promote ongoing discussions and documentation and target persons with dementia and their surrogates in various countries.
Many persons with dementia and their surrogates have limited knowledge about ACP; thus, more nurse-led ACP programs that reflect dementia stages may help them prepare for the situations in which persons with dementia lack decision-making capacity.
对于如何随着痴呆症的进展改变预先医疗计划（ACP）干预措施，人们知之甚少。因此，本系统评价的主要目的是比较痴呆症各阶段的 ACP 干预措施的特征。我们还确定了护士在为痴呆症患者及其代理人实施 ACP 干预措施中的作用。
ACP 干预研究的系统评价。
在搜索 PubMed、Web of Science、EMBASE、PsycArticles、护理学和联合健康文献累积索引（CINAHL）和 Scopus 之后，最终样本包括 11 项研究，代表 10 项干预措施。我们进行了质量评估，并提取了有关痴呆症阶段、干预特征以及护士在干预中的作用的数据。提取的数据根据痴呆症阶段进行分类，并进行分析以确定干预特征之间的共同点和差异。
有三项 ACP 干预措施专注于轻度痴呆症，而七项则针对晚期痴呆症。我们观察到四个主要发现。首先，我们发现两个痴呆症阶段的干预对象之间存在重大差异。其次，大多数 ACP 干预措施都包括针对个人的、面对面的互动，对个人生活目标和价值观、护理目标以及对未来护理的偏好进行结构化讨论。第三，缺乏旨在促进持续讨论和文件记录的 ACP 干预措施。最后，护士在实施 ACP 干预措施中发挥了重要作用。
研究结果表明，需要更多以护士为主导的、与痴呆症相关的 ACP 干预措施。此外，ACP 干预措施应促进持续的讨论和文件记录，并针对不同国家的痴呆症患者及其代理人。
许多痴呆症患者及其代理人对 ACP 的了解有限；因此，更多以护士为主导的、反映痴呆症阶段的 ACP 计划可能有助于他们为痴呆症患者丧失决策能力的情况做好准备。
