“穿越艰难地形”。通过多学科病例会议在老年护理机构中进行预先护理规划：一项质性访谈研究，探索家庭、工作人员和健康专业人员的经历。
'Traversing difficult terrain'. Advance care planning in residential aged care through multidisciplinary case conferences: A qualitative interview study exploring the experiences of families, staff and health professionals.
作者信息
Rainsford Suzanne, Hall Dykgraaf Sally, Kasim Rosny, Phillips Christine, Glasgow Nicholas
机构信息
Rural Clinical School, Medical School, Australian National University, Canberra, ACT, Australia.
Clare Holland House, Calvary Health Care Bruce, Canberra, ACT, Australia.
出版信息
Palliat Med. 2021 Jun;35(6):1148-1157. doi: 10.1177/02692163211013250. Epub 2021 May 21.
BACKGROUND
Advance care planning improves the quality of end-of-life care for older persons in residential aged care; however, its uptake is low. Case conferencing facilitates advance care planning.
AIM
To explore the experience of participating in advance care planning discussions facilitated through multidisciplinary case conferences from the perspectives of families, staff and health professionals.
DESIGN
A qualitative study (February-July 2019) using semi-structured interviews.
SETTING
Two residential aged care facilities in one Australian rural town.
PARTICIPANTS
Fifteen informants [family ( = 4), staff ( = 5), health professionals ( = 6)] who had participated in advance care planning discussions facilitated through multidisciplinary case conferences.
RESULTS
Advance care planning was like navigating an emotional landscape while facing the looming loss of a loved one. This emotional burden was exacerbated for substitute decision-makers, but made easier if the resident had capacity to be involved or had previously made their wishes clearly known. The 'conversation' was not a simple task, and required preparation time. Multidisciplinary case conferences facilitated informed decision-making and shared responsibility. Opportunity to consider all care options provided families with clarity, control and a sense of comfort. This enabled multiple stakeholders to bond and connect around the resident.
CONCLUSION
While advance care planning is an important element of high quality care it involves significant emotional labour and burden for families, care staff and health professionals. It is not a simple administrative task to be completed, but a process that requires time and space for reflection and consensus-building to support well-considered decisions. Multidisciplinary case conferences support this process.
背景
预先护理计划可提高老年住院护理患者临终关怀的质量；然而，其采用率较低。病例讨论会有助于预先护理计划的实施。
目的
从家属、工作人员和健康专业人员的角度，探讨通过多学科病例讨论会促进预先护理计划讨论的经验。
设计
一项定性研究（2019年2月至7月），采用半结构式访谈。
地点
澳大利亚一个乡村小镇的两家老年住院护理机构。
参与者
15名受访者[家属（4名）、工作人员（5名）、健康专业人员（6名）]，他们参与了通过多学科病例讨论会促进的预先护理计划讨论。
结果
预先护理计划就像是在面对亲人即将离世时，在情感的 landscape 中导航。这种情感负担对于替代决策者来说更为加重，但如果居民有能力参与或之前已经明确表达了自己的意愿，就会变得更容易。“对话”不是一项简单的任务，需要准备时间。多学科病例讨论会有助于做出明智的决策并分担责任。考虑所有护理选择的机会让家属更加清晰、掌控局面并感到安心。这使得多个利益相关者围绕居民建立联系并相互沟通。
结论
虽然预先护理计划是高质量护理的重要组成部分，但它给家属、护理人员和健康专业人员带来了巨大的情感劳动和负担。它不是一项简单的行政任务，而是一个需要时间和空间进行反思和建立共识以支持深思熟虑的决策的过程。多学科病例讨论会支持这一过程。
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