Department of Public and Occupational Health, Amsterdam UMC, Location VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Expertise Center for Palliative Care, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
BMC Geriatr. 2022 Jul 5;22(1):558. doi: 10.1186/s12877-022-03256-4.
General Practitioners (GPs) are central in the care of Dutch older people and in a good position to have Advance Care Planning (ACP) conversations. Interview studies reveal that the doctor-patient relationship is important when initiating ACP conversations and can also be influenced by ACP conversations. We aimed to examine the association between having an ACP conversation and the patient feeling the GP knows him or her and the patient trusting the GP and vice versa.
Implementation of ACP in primary care was evaluated in a pre-and post design. Questionnaires before implementation of ACP and 14 months later were sent to patients aged 75 years or older within 10 GP-practices and 2 care homes. Multivariable logistic regression was used to model the relationship between ACP conversations during implementation and the patient-GP relationship before implementation. Odds ratios were adjusted for potential confounders. Generalized ordered logistic regression was used to model the relationship between the changes in patient-GP relationship before and after implementation and ACP conversations during implementation.
Four hundred fifty-eight patients filled out the pre- and post-test questionnaire. There was no association between the GP knowing the patient and trust in the pre-test and having an ACP conversation during the implementation. For people who had had an ACP conversation at the end of the implementation period their trust remained more often the same or was higher after implementation (trust to provide good care OR 2.93; trust to follow their wishes OR 2.59), compared to patients who did not have an ACP conversation. A reduction in trust was less likely to happen to patients who had an ACP conversation compared to patients who did not have an ACP conversation.
Although we have not found evidence for trust as a prerequisite for ACP conversations, this paper shows that ACP conversations can be beneficial for the doctor-patient relationship.
全科医生（GP）是荷兰老年人护理的核心，他们有很好的条件进行预先护理计划（ACP）对话。访谈研究表明，当启动 ACP 对话时，医患关系很重要，并且可以通过 ACP 对话来影响医患关系。我们旨在研究进行 ACP 对话与患者感觉 GP 了解他或她以及患者信任 GP 之间的关系。
在预前后设计中评估初级保健中 ACP 的实施情况。在实施 ACP 之前和之后的 14 个月，向 10 个 GP 实践和 2 个养老院中年龄在 75 岁或以上的患者发送了问卷。使用多变量逻辑回归模型来模拟实施过程中 ACP 对话与实施前患者与 GP 关系之间的关系。调整了可能的混杂因素的比值比。使用广义有序逻辑回归模型来模拟实施前后患者与 GP 关系的变化与实施过程中 ACP 对话之间的关系。
458 名患者填写了预测试和后测试问卷。在预测试中，GP 了解患者与信任之间没有关系，与实施期间进行 ACP 对话也没有关系。对于在实施结束时进行 ACP 对话的人，他们的信任在实施后保持不变或更高（提供良好护理的信任 OR 2.93；遵循他们意愿的信任 OR 2.59），与没有进行 ACP 对话的患者相比。与没有进行 ACP 对话的患者相比，进行 ACP 对话的患者不太可能降低信任。
尽管我们没有发现信任是 ACP 对话的前提条件的证据，但本文表明 ACP 对话可以有益于医患关系。
