Department of Medicine, Stanford University, Palo Alto, California, USA.
Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
J Palliat Med. 2022 Mar;25(3):355-360. doi: 10.1089/jpm.2022.0016.
Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.
完成预先医疗照护计划（ACP）流程和/或预先指示本应使患者在生命末期得到他们所期望的照护。然而，三十年来的研究表明，事实并非如此。ACP 一直是姑息治疗领域发展科学的先锋。ACP 可能会带来一些积极的结果，例如降低代理人的悲伤程度。然而，进一步的 ACP 研究似乎并不能确保重病患者得到与目标一致的照护。到目前为止，姑息治疗研究和宣传的一个不幸后果是，许多医院系统产生了一种错误的观念，即认为仅实施 ACP 计划就能解决他们的姑息治疗问题。最好的情况是，ACP 只是姑息治疗工具箱中的一个工具。需要新的工具。考虑到我们的资源有限，未来的研究应该更侧重于改善症状管理、更好的护理模式以及确保符合目标的系统的工具，这些工具应满足医疗保健系统旨在满足的人群的需求。
