Department of Internal Medicine, Nykøbing Falster Sygehus, Nykobing, Denmark.
Department of Social Medicine, Frederiksberg Hospital, Frederiksberg, Denmark.
BMJ Open. 2022 Mar 8;12(3):e056115. doi: 10.1136/bmjopen-2021-056115.
Most previous studies on advance care planning (ACP) have focused on patients with specific diseases and only a few on frail ageing individuals. We therefore decided to examine the perspective of geriatric patients on ACP. Our research questions include if, when, with whom and with which content geriatric patients wish to have ACP conversations.
Participants were interviewed either in the hospital or in their own home. The interviewer followed a semistructured interview guide. Interviews were transcribed and analysed using the systemic text condensation method.
Geriatric department in a regional hospital in a rural area in Region Zealand, Denmark.
We included 11 geriatric patients aged above 65 who had been referred for geriatric inpatient or outpatient assessment. Participants were clinically judged by experienced geriatricians to have sufficient physical and mental capacity to take part in an interview.
This study's main finding is that geriatric patients have varying preferences and feelings towards ACP. Some expressed concerns about ACP, especially regarding personal fear to talk about end-of-life (EOL) decisions, and whether a busy healthcare system has the resources to conduct ACP. Proper timing of ACP seemed unrelated to specific age but related to perception of health situation. The health professional involved should be well trained and a person the participant could trust. Most participants wanted family members to participate. Concerning content, participants mentioned quality of life, fear of losing their spouse, earlier experience with death, and practical concerns regarding funeral and will.
Among geriatric patients, feelings towards ACP are mixed. Even participants who were generally positive towards the concept uttered concerns about the circumstances when talking about EOL topics. Health professionals therefore should approach ACP discussions with caution. Further studies aiming to develop guidelines describing the proper way to introduce and perform ACP in this patient group are needed.
大多数关于预先医疗指示（ACP）的既往研究都集中于特定疾病的患者，而仅有少数研究关注体弱的老年个体。因此，我们决定研究老年患者对 ACP 的看法。我们的研究问题包括老年患者希望何时、与谁以及讨论哪些内容进行 ACP 对话。
参与者在医院或家中接受访谈。访谈者遵循半结构化访谈指南。使用系统文本浓缩法对访谈进行转录和分析。
丹麦西兰大区农村地区一家区域医院的老年科。
我们纳入了 11 名年龄在 65 岁以上、因老年住院或门诊评估而转介的老年患者。经验丰富的老年科医生根据患者的临床表现判断，认为其有足够的身体和精神能力参加访谈。
本研究的主要发现是，老年患者对 ACP 的偏好和感受各不相同。一些患者对 ACP 表示担忧，特别是对谈论临终（EOL）决策的个人恐惧，以及忙碌的医疗体系是否有资源进行 ACP 的担忧。适当的 ACP 时间似乎与特定年龄无关，而与对健康状况的感知有关。参与的医疗保健专业人员应经过良好培训，且是患者信任的人。大多数参与者希望家庭成员参与。关于内容，参与者提到了生活质量、担心失去配偶、对死亡的早期经历以及关于葬礼和遗嘱的实际问题。
在老年患者中，对 ACP 的看法喜忧参半。即使是对这一概念普遍持积极态度的参与者，也对谈论 EOL 话题时的情况表示担忧。因此，医疗保健专业人员在进行 ACP 讨论时应谨慎。需要进一步研究，以制定描述在这一患者群体中适当引入和实施 ACP 的指南。
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