Alam Adnan, Barton Christopher, Prathivadi Pallavi, Mazza Danielle
Hobart Place General Practice, Level 2 & 3, 28 University Avenue, Canberra, ACT 2601, Australia; and Corresponding author.
Department of General Practice, Monash University, Level 1, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
Aust J Prim Health. 2022 Feb;28(1):69-75. doi: 10.1071/PY20307.
As the population ages, so does the prevalence of dementia, a condition in which timely advance care planning (ACP) is recommended. This study explored the barriers and enablers of ACP for Australian GPs caring for people with dementia. Semi-structured qualitative telephone interviews informed by the theoretical domains framework (TDF) were conducted with 16 GPs from the south-east region of metropolitan Melbourne. The most prevalent domains of the TDF were: (1) environmental context and resources; (2) beliefs about consequences; and (3) social/professional role and identity. Further thematic analysis found that: (1) ACP was felt to be within the scope of general practice, but more so before the onset of dementia because lack of confidence in capacity assessment acted as a barrier once a diagnosis was made; (2) beliefs about the perceived benefits of ACP motivated GPs to engage patients in ACP; and (3) doctors felt that patients were often reluctant to discuss ACP, especially in the time-pressured context of the standard consultation. This study's use of the TDF provides direction for potential interventions to alleviate challenges faced by Australian GPs with ACP in dementia. Improving ACP in general practice may require a focus on public health campaigns to educate patients about the benefits of ACP before the onset of dementia. GPs' difficulty assessing a patient's decisional capacity may be addressed through skills development workshops.
随着人口老龄化，痴呆症的患病率也在上升，而对于这种病症，建议进行及时的预先护理规划（ACP）。本研究探讨了澳大利亚全科医生（GP）在护理痴呆症患者时进行ACP的障碍和促成因素。采用理论领域框架（TDF）进行半结构化定性电话访谈，对来自墨尔本东南部大都市地区的16名全科医生进行了访谈。TDF中最普遍的领域是：（1）环境背景和资源；（2）对后果的信念；（3）社会/职业角色和身份。进一步的主题分析发现：（1）ACP被认为属于全科医疗的范畴，但在痴呆症发病前更是如此，因为一旦确诊，对能力评估缺乏信心就成为了障碍；（2）对ACP感知益处的信念促使全科医生让患者参与ACP；（3）医生们认为患者往往不愿意讨论ACP，尤其是在标准会诊时间紧迫的情况下。本研究对TDF的运用为缓解澳大利亚全科医生在痴呆症ACP方面面临的挑战的潜在干预措施提供了方向。改善全科医疗中的ACP可能需要关注公共卫生运动，以便在痴呆症发病前教育患者了解ACP的益处。全科医生在评估患者决策能力方面的困难可以通过技能发展研讨会来解决。
