School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China.
Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong 999077, China.
Int J Environ Res Public Health. 2022 Apr 28;19(9):5358. doi: 10.3390/ijerph19095358.
Advance care planning (ACP) facilitates individuals to proactively make decisions on their end-of-life care when they are mentally competent. It is highly relevant to older adults with frailty because they are more vulnerable to cognitive impairment, disabilities, and death. Despite devoting effort to promoting ACP among them, ACP and advance directive completion rates remain low. This study aims to explore the experiences among frail older adults who did not complete an advance directive after an ACP conversation. We conducted a thematic analysis of audiotaped nurse-facilitated ACP conversations with frail older adults and their family members. We purposively selected ACP conversations from 22 frail older adults in the intervention group from a randomized controlled trial in Hong Kong who had ACP conversation with a nurse, but did not complete an advance directive upon completing the intervention. Three themes were identified: "Refraining from discussing end-of-life care", "Remaining in the here and now", and "Relinquishing responsibility over end-of-life care decision-making". Participation in ACP conversations among frail older adults and their family members might improve if current care plans are integrated so as to increase patients' motivation and support are provided to family members in their role as surrogate decision-makers.
预先医疗指示（ACP）是指患者在有能力时，对临终护理预先做出决定。它对体弱的老年人非常重要，因为他们更容易出现认知障碍、残疾和死亡。尽管已经努力在他们中推广 ACP，但 ACP 和预先医疗指示的完成率仍然很低。本研究旨在探讨在进行 ACP 对话后，未完成预先医疗指示的体弱老年人的体验。我们对香港一项随机对照试验中 22 名接受过护士协助 ACP 对话的体弱老年人及其家属的录音进行了主题分析。我们从干预组中选择了与护士进行过 ACP 对话但在完成干预后未完成预先医疗指示的 22 名体弱老年人的 ACP 对话。确定了三个主题：“避免讨论临终护理”、“活在当下”和“放弃临终护理决策的责任”。如果将现行的护理计划整合起来，以增加患者的动力，并为家属作为替代决策者的角色提供支持，那么体弱老年人及其家属参与 ACP 对话的情况可能会得到改善。
