Dzou Tiffany, Moriguchi Jaime D, Doering Lynn, Eastwood Jo-Ann, Pavlish Carol, Pieters Huibrie C
Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
Heart Lung. 2022 Jul-Aug;54:34-41. doi: 10.1016/j.hrtlng.2022.03.010. Epub 2022 Mar 23.
People living with mechanical circulatory support (MCS) are at risk for catastrophic complications that require advance care planning (ACP) as part of the preimplantation work up. Palliative care consultants are a mandatory and essential component of the MCS team tasked to enhance conversations. However, in reality, there is often a serious deficiency of ACP communication after the initial implant counseling. A better understanding of opportunities and challenges in ACP can mobilize intensive care unit and step-down nurses to bridge this gap in crucial communication.
To identify and describe MCS individuals' perceptions of opportunities and challenges for ongoing ACP communication.
A constructivist grounded theory study was conducted with 24 MCS individuals from 2 medical centers in Southern California. Semi-structured interviews were audio recorded, transcribed, and reviewed for accuracy. The data were systematically analyzed through 3 rounds of coding.
MCS clinicians, supportive others, and peers with MCS were identified as stakeholders in ongoing communication. Four categories of opportunities and challenges for ongoing ACP were synthesized from the narratives: identifying context and timing, sharing information, understanding of ACP, and assessing satisfaction. All participants reported a preference for MCS clinicians, including nurses, to initiate ACP conversations.
Understanding opportunities and challenges is key to facilitating ongoing ACP discussions among MCS patients. MCS-trained nurses are positioned to address the dearth of ongoing ACP by facilitating these sensitive discussions. The personal accounts of this sample serve to guide future research and structure training to prepare MCS clinicians for primary palliative care.
接受机械循环支持（MCS）的患者面临灾难性并发症的风险，这需要在植入前的检查中进行预先护理计划（ACP）。姑息治疗顾问是MCS团队中不可或缺的重要组成部分，其任务是加强沟通。然而，实际上，在最初的植入咨询后，ACP沟通往往严重不足。更好地了解ACP中的机遇和挑战可以促使重症监护病房和降级护理护士弥合这一关键沟通中的差距。
识别并描述MCS患者对持续进行ACP沟通的机遇和挑战的看法。
对来自南加州2个医疗中心的24名MCS患者进行了建构主义扎根理论研究。半结构化访谈进行了录音、转录并检查准确性。通过三轮编码对数据进行系统分析。
MCS临床医生、支持人员以及其他MCS患者被确定为持续沟通中的利益相关者。从叙述中总结出了持续进行ACP的四类机遇和挑战：确定背景和时机、分享信息、对ACP的理解以及评估满意度。所有参与者都表示倾向于由包括护士在内的MCS临床医生发起ACP对话。
了解机遇和挑战是促进MCS患者之间持续进行ACP讨论的关键。经过MCS培训的护士有能力通过促进这些敏感讨论来解决持续进行的ACP沟通不足的问题。该样本的个人叙述有助于指导未来的研究并构建培训内容，以使MCS临床医生为初级姑息治疗做好准备。
