共同照护计划：医学个体化和尊重自主权的非凡工具。
Shared care plan: an extraordinary tool for the personalization of medicine and respect for self-determination.
机构信息
Array.
Department of Molecular Medicine, Legal Medicine, University of Padua, Padua, Italy.
出版信息
Acta Biomed. 2020 Apr 29;92(1):e2021001. doi: 10.23750/abm.v92i1.9597.
BACKGROUND
On 22 December 2017, Law No. 219 was approved in Italy. This law provides citizens with effective tools with which to express healthcare decisions: namely, advance treatment directives (ATD) and shared care plans (SCP).
METHODS
This article presents an analysis of 70 SCP cases carried out in a tertiary hospital in Italy during the period between 01.02.2018 and 29.02.2020 inclusive.
RESULTS
In 90% of cases, the objective of the plan pertained to situations regarding patients' refusal of transfusions of blood components, the majority (97%) due to their belonging to the religious movement of Jehovah's Witnesses. 46% of the sample had drafted ATDs. The course of treatment recommended by the attending physicians was confirmed in 93% of the SCP cases. Trustees were appointed in 96% of cases. In 55% of cases, patients assigned trustees with attestative functions and the remaining 45% with creative functions. The results demonstrate that each patient personally dictates his or her wishes and the role assigned to the trustee. SCP meetings serve as a useful tool for providing the patient and his or her relatives with information, and for appointing a trustee. However, it has never been necessary to solicit the intervention of the trustee following a surgical operation.
CONCLUSIONS
The SCP has proven to be an essential tool in achieving the objective of personalised medicine. However, there is still notable passivity in its application. Further effort is required in order for it to become a common asset in clinical practice.
背景
2017 年 12 月 22 日，意大利通过了第 219 号法案。该法案为公民提供了表达医疗决策的有效工具：即预先治疗指令（ATD）和共同护理计划（SCP）。
方法
本文分析了意大利一家三级医院在 2018 年 2 月 1 日至 2020 年 2 月 29 日期间进行的 70 例 SCP 案例。
结果
在 90%的情况下，计划的目标涉及患者拒绝输血的情况，其中大多数（97%）是因为他们属于耶和华见证人的宗教运动。46%的样本起草了 ATD。主治医生推荐的治疗方案在 93%的 SCP 病例中得到了确认。在 96%的情况下任命了受托人。在 55%的情况下，患者指定了具有证明职能的受托人，其余 45%具有创造性职能的受托人。结果表明，每位患者都亲自决定自己的意愿和受托人的角色。SCP 会议是向患者及其家属提供信息和任命受托人的有用工具。然而，在进行手术操作后，从未有必要请求受托人进行干预。
结论
SCP 已被证明是实现个性化医疗目标的重要工具。然而，在其应用方面仍然存在明显的被动性。需要进一步努力，使其成为临床实践中的共同资产。
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