Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry.
Br J Gen Pract. 2021 Jun 24;71(708):e550-e560. doi: 10.3399/BJGP.2020.0973. Print 2021 Jul.
Advance care planning (ACP) can improve the quality of life of patients suffering from heart failure (HF). However, primary care healthcare professionals (HCPs) find ACP difficult to engage with and patient care remains suboptimal.
To explore the views of primary care HCPs on how to improve their engagement with ACP in HF.
A qualitative interview study with GPs and primary care nurses in England.
Semi-structured interviews were conducted with a purposive sample of 24 primary care HCPs. Data were analysed using reflexive thematic analysis.
Three main themes were constructed from the data: ACP as integral to holistic care in HF; potentially limiting factors to the doctor-patient relationship; and approaches to improve professional performance. Many HCPs saw the benefits of ACP as synonymous with providing holistic care and improving patients' quality of life. However, some feared that initiating ACP could irrevocably damage their doctor-patient relationship. Their own fear of death and dying, a lack of disease-specific communication skills, and uncertainty about the right timing were significant barriers to ACP. To optimise their engagement with ACP in HF, HCPs recommended better clinician-patient dialogue through question prompts, enhanced shared decision-making approaches, synchronising ACP across medical specialties, and disease-specific training.
GPs and primary care nurses are vital to deliver ACP for patients suffering from HF. HCPs highlighted important areas to improve their practice and the urgent need for investigations into better clinician-patient engagement with ACP.
预先医疗照护计划（ACP）可以提高心力衰竭（HF）患者的生活质量。然而，初级保健医护人员（HCPs）发现很难参与 ACP，患者的护理仍然不尽如人意。
探讨初级保健 HCPs 如何改善他们在 HF 中的 ACP 参与度的观点。
在英格兰，对全科医生和初级保健护士进行了一项定性访谈研究。
采用目的抽样法对 24 名初级保健 HCPs 进行半结构式访谈。使用反思性主题分析对数据进行分析。
从数据中构建了三个主要主题：ACP 是 HF 整体护理的组成部分；可能限制医患关系的因素；以及改善专业表现的方法。许多 HCPs 认为 ACP 的好处与提供整体护理和提高患者的生活质量是等同的。然而，一些人担心启动 ACP 可能会不可逆转地破坏他们的医患关系。他们自己对死亡和濒死的恐惧、缺乏特定疾病的沟通技巧以及对正确时机的不确定性是 ACP 的重要障碍。为了优化他们在 HF 中的 ACP 参与度，HCPs 建议通过问题提示改善医患对话，增强共享决策方法，在医疗专业之间同步 ACP，并进行特定疾病的培训。
全科医生和初级保健护士是为 HF 患者提供 ACP 的关键。HCPs 强调了改善实践的重要领域，迫切需要调查更好的医患 ACP 参与度。
