Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, University Hospital of Southern Denmark, Vejle, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Scand J Prim Health Care. 2022 Mar;40(1):57-66. doi: 10.1080/02813432.2022.2036481. Epub 2022 Feb 11.
To explore patients' and physicians' perspectives on a decision-making conversation for life-sustaining treatment, based on the Danish model of the American Physician Orders for Life Sustaining Treatment (POLST) form.
Semi-structured interviews following a conversation about preferences for life-sustaining treatment.
Danish hospitals, nursing homes, and general practitioners' clinics.
Patients and physicians.
Qualitative analyses of interview data.
After participating in a conversation about life-sustaining treatment using the Danish POLST form, a total of six patients and five physicians representing different settings and age groups participated in an interview about their experience of the process. Within the main research questions, six subthemes were identified: Timing, relatives are key persons, clarifying treatment preferences, documentation across settings, strengthening patient autonomy, and structure influences conversations. Most patients and physicians found having a conversation about levels of life-sustaining treatment valuable but also complicated due to the different levels of knowledge and attending to individual patient needs and medical necessities. Relatives were considered as key persons to ensure the understanding of the treatment trajectory and the ability to advocate for the patient in case of a medical crisis. The majority of participants found that the conversation strengthened patient autonomy.
Patients and physicians found having a conversation about levels of life-sustaining treatment valuable, especially for strengthening patient autonomy. Relatives were considered key persons. The timing of the conversation and securing sufficient knowledge for shared decision-making were the main perceived challenges.KEY POINTSConversations about preferences for life-sustaining treatment are important, but not performed systematically.When planning a conversation about preferences for life-sustaining treatment, the timing of the conversation and the inclusion of relatives are key elements.Decision-making conversations can help patients feel in charge and less alone, and make it easier for health professionals to provide goal-concordant care.Using a model like the Danish POLST form may help to initiate, conduct and structure conversations about preferences for life-sustaining treatment.
基于丹麦版美国医师医疗指令（POLST）表单，探讨患者和医生对维持生命治疗决策对话的看法。
基于对维持生命治疗偏好的对话，进行半结构式访谈。
丹麦医院、疗养院和全科医生诊所。
患者和医生。
对访谈数据的定性分析。
在使用丹麦版 POLST 表单进行了维持生命治疗的对话后，来自不同环境和年龄组的 6 名患者和 5 名医生参与了关于他们对话体验的访谈。在主要研究问题内，确定了 6 个副标题：时机、亲属是关键人物、澄清治疗偏好、跨环境记录、增强患者自主权、结构影响对话。大多数患者和医生认为进行维持生命治疗水平的对话很有价值，但由于知识水平的不同以及关注个体患者的需求和医疗必要性，也使对话变得复杂。亲属被认为是确保理解治疗轨迹和在医疗危机时能够为患者辩护的关键人物。大多数参与者认为对话增强了患者的自主权。
患者和医生认为进行维持生命治疗水平的对话很有价值，尤其是增强了患者的自主权。亲属被认为是关键人物。对话的时机和确保共享决策所需的充分知识是主要的感知挑战。
关于维持生命治疗偏好的对话很重要，但没有系统地进行。
计划进行维持生命治疗偏好的对话时，对话的时机和亲属的参与是关键要素。
决策对话可以帮助患者感到掌控局面，不那么孤单，并且使卫生专业人员更容易提供与目标一致的护理。
使用像丹麦 POLST 表单这样的模型可以帮助启动、进行和构建关于维持生命治疗偏好的对话。
