养老院患者的预先医疗照护计划的流行程度、内容和意义。
Prevalence, content and significance of advance care planning in nursing home patients.
机构信息
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Primary Health Care Centre in Kisa, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
出版信息
Scand J Prim Health Care. 2022 Mar;40(1):29-38. doi: 10.1080/02813432.2022.2036429. Epub 2022 Feb 16.
OBJECTIVE
Studies on advance care planning in nursing homes are rare, and despite their demonstrated favourable effects on end-of-life care, advance care plans are often lacking. Therefore, we wished to explore: (i) the prevalence of advance care plans in a Swedish nursing home setting using two different definitions, (ii) the content of advance care plans, (iii) adherence to the content of care plans and (iv) possible associations between the presence of advance care planning and background characteristics, physician attendance and end-of-life care.
DESIGN
Retrospective chart review.
SETTING
Twenty-two nursing homes in Sweden.
SUBJECTS
A total of 367 deceased patients (included between 1 June 2018 and 23 May 2020) who had lived in nursing homes.
MAIN OUTCOME MEASURES
Electronic health record data on the prevalence of advance care plans with two different definitions and variables regarding background characteristics, physician attendance and end-of-life care, were collected.
RESULTS
Of the study population, 97% had a limited care plan (ACP I) documented. When using the comprehensive definition (ACP II), also including patient's preferences and involvement of family members in advance care planning, the prevalence was 77%. Patients with dementia more often had care plans, and a higher physician attendance was associated with presence of advance care plans. Prescription of palliative drugs and information to family members of the patient's deterioration and impending death were more common in patients with care plans compared to those where such plans were missing. There was adherence to the care plan content.
CONCLUSION
In contrast to previous research, this study showed a high prevalence of advance care plans in nursing home patients. Patients with care plans more frequently received prescriptions of palliative drugs and their family members were informed to a greater extent about the patient's deterioration and impending death compared to those without care plans. These aspects are often seen as vital components of good palliative care.Key pointsStudies on advance care planning in nursing homes are rare, and despite their demonstrated positive effects on end-of-life care, advance care plans are often lacking.The present study revealed a high prevalence of advance care plans (77-97% depending on definition) in nursing home patients.Patients with dementia more often had advance care plans, and a higher physician attendance was associated with presence of care plans.Advance care plans were positively associated with components of good palliative care, such as prescriptions of palliative drugs and information to family.
目的
养老院的预先护理计划研究很少，尽管这些计划已经证明对临终关怀有积极影响，但预先护理计划往往缺乏。因此，我们希望探讨：（i）使用两种不同定义，在瑞典养老院环境中预先护理计划的流行程度；（ii）预先护理计划的内容；（iii）护理计划内容的遵守情况；以及（iv）预先护理计划的存在与背景特征、医生就诊情况和临终关怀之间的可能关联。
设计
回顾性图表审查。
设置
瑞典 22 家养老院。
研究对象
共有 367 名已故患者（包括 2018 年 6 月 1 日至 2020 年 5 月 23 日期间居住在养老院的患者）。
主要观察指标
收集有关两种不同定义的预先护理计划的流行程度以及背景特征、医生就诊情况和临终关怀的变量的电子健康记录数据。
结果
在所研究的人群中，97%的人记录了有限的护理计划（ACP I）。当使用包括患者偏好和家庭成员参与预先护理计划的综合定义（ACP II）时，流行率为 77%。患有痴呆症的患者更有可能制定护理计划，而医生就诊次数较多与存在预先护理计划有关。与没有护理计划的患者相比，有护理计划的患者更常开具姑息治疗药物，并且其家属更经常收到关于患者病情恶化和即将死亡的信息。护理计划的内容得到了遵守。
结论
与之前的研究相比，本研究表明养老院患者的预先护理计划的流行率很高。与没有护理计划的患者相比，有护理计划的患者更常开具姑息治疗药物，并且其家属更经常收到关于患者病情恶化和即将死亡的信息。这些方面通常被视为良好姑息治疗的重要组成部分。
关键点
养老院的预先护理计划研究很少，尽管这些计划已经证明对临终关怀有积极影响，但预先护理计划往往缺乏。本研究揭示了养老院患者中预先护理计划的高流行率（根据定义，77%-97%）。患有痴呆症的患者更有可能制定预先护理计划，而医生就诊次数较多与护理计划的存在有关。预先护理计划与良好姑息治疗的组成部分呈正相关，例如开具姑息治疗药物和向家属提供信息。
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