From the Keck School of Medicine of USC, University of Southern California, Dept. of Family Medicine and Geriatrics, Alhambra (ACK, KK, BO); RAND Corporation, Boston, MA (JIB); RAND Corporation, Santa Monica, CA (SCA).
J Am Board Fam Med. 2021 Mar-Apr;34(2):375-386. doi: 10.3122/jabfm.2021.02.200270.
Advance care planning (ACP) is critical for older adults with heart failure; however, patient-level and clinician-level barriers exist. Although a group visit (GV) approach to engage patients in ACP has proven effective among general geriatric populations, little is known about clinician perceptions/likelihood of referral.
Qualitative study to understand clinician perspectives on GVs for ACP among older adult patients with heart failure and caregivers. Twenty physicians and advance practice providers participated in telephone-based interviews guided by a semistructured research protocol. Transcripts were analyzed using a grounded theory approach.
Results highlight variability in clinician engagement in ACP but greater agreement around the factors that prompt discussions. Qualitative themes included (1) inherent properties of GVs (characteristics that make GVs ideal for most but less ideal for some, risk-to-benefit ratio); (2) purpose of GVs (general education, "priming the pump" for subsequent discussions, providing tools for action); and (3) format and procedures for GVs (inclusion/exclusion considerations, organizing by unifying characteristic, link back to clinicians).
This is the first study to gain clinician insights into ACP GVs specific to patients and caregivers affected by heart failure. Results shed light on an important topic and suggest key considerations for conducting GVs for ACP.
预先医疗指示（ACP）对心力衰竭的老年患者至关重要，但患者层面和临床医生层面都存在障碍。虽然小组访问（GV）方法已被证明在一般老年人群中有效地参与 ACP，但对于临床医生对 GV 的看法/转介意愿知之甚少。
这是一项定性研究，旨在了解临床医生对心力衰竭老年患者及其照顾者进行 ACP 的 GV 的看法。20 名医生和高级执业护士参加了基于电话的访谈，访谈内容由半结构化研究方案指导。使用扎根理论方法分析转录本。
研究结果突出了临床医生在 ACP 方面参与的差异，但在促使讨论的因素方面有更多的共识。定性主题包括：（1）GV 的固有特性（使 GV 对大多数人理想但对某些人不太理想的特征，风险效益比）；（2）GV 的目的（一般教育、“为后续讨论做好准备”、提供行动工具）；（3）GV 的格式和程序（纳入/排除考虑因素、按统一特征组织、与临床医生联系）。
这是第一项针对受心力衰竭影响的患者及其照顾者的 ACP GV 获得临床医生见解的研究。研究结果阐明了一个重要的主题，并提出了进行 ACP GV 的关键考虑因素。
