Northern Health, Melbourne, Victoria, Australia.
University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2022 May;52(5):776-784. doi: 10.1111/imj.15374.
Advance care planning (ACP) is a process by which people communicate their healthcare preferences and values, planning for a time when they are unable to voice them. Within residential aged care facilities (RACF), both the completion and the clarity of ACP documents are varied and, internationally, medical treatment orders have been used to address these issues.
In this study, goals of patient care (GOPC) medical treatment orders were introduced alongside usual ACP in three RACF to improve healthcare decision-making for residents. This study explored the experiences of RACF healthcare providers with ACP and GOPC medical treatment orders.
The study used an explanatory descriptive approach. Within three RACF where the GOPC medical treatment orders had been introduced, focus groups and interviews with healthcare providers were performed. The transcribed interviews were analysed thematically.
Healthcare providers not only reported support for ACP and GOPC but also discussed many problematic issues. Analysis of the data identified four main themes: enablers, barriers, resident autonomy and advance documentation (ACP and GOPC).
Healthcare providers identified ACP and GOPC as positive tools for assisting with medical decision-making for residents. Although barriers exist in completion and activation of plans, healthcare providers described them as progressing resident-centred care. Willingness to follow ACP instructions was reported to be reduced by lack of trust by clinicians. Families were also reported to change their views from those documented in family-completed ACP, attributed to poor understanding of their purpose. Participants reported that GOPC led to clearer documentation of residents' medical treatment plans rather than relying on ACP documents alone.
预先医疗照护计划（ACP）是一个人们沟通其医疗偏好和价值观、为自己无法表达意见时做准备的过程。在养老院中，ACP 文件的完成情况和清晰度各不相同，在国际上，已经使用医疗治疗指令来解决这些问题。
在这项研究中，在三个养老院中引入了患者照护目标（GOPC）医疗治疗指令，以改善居民的医疗决策。本研究探讨了养老院医疗保健提供者对 ACP 和 GOPC 医疗治疗指令的体验。
该研究采用了解释性描述方法。在引入 GOPC 医疗治疗指令的三个养老院中，对医疗保健提供者进行了焦点小组和访谈。对转录的访谈进行了主题分析。
医疗保健提供者不仅报告了对 ACP 和 GOPC 的支持，还讨论了许多有问题的问题。数据分析确定了四个主要主题：促进因素、障碍、居民自主权和预先文件（ACP 和 GOPC）。
医疗保健提供者认为 ACP 和 GOPC 是协助居民医疗决策的积极工具。尽管在制定和激活计划方面存在障碍，但医疗保健提供者描述说，这些障碍正在推进以居民为中心的护理。由于临床医生缺乏信任，报告称遵守 ACP 指示的意愿降低。据报道，家属也改变了他们在由家属完成的 ACP 中记录的观点，这归因于他们对 ACP 目的的理解不佳。参与者报告说，GOPC 导致了更清晰的居民医疗治疗计划的记录，而不是仅仅依赖 ACP 文件。
