表达他们的选择：为癌症和其他严重疾病的青少年和年轻成人进行预先医疗护理计划。
Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions.
机构信息
Pediatric Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, MD.
Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA 92868.
出版信息
Palliat Support Care. 2022 Aug;20(4):462-470. doi: 10.1017/S1478951521001462.
OBJECTIVES
To determine whether engaging in advance care planning (ACP) using a formal tool, (VMC), would alleviate adolescent and young adults (AYAs) anxiety surrounding ACP and increase social support and communication about end-of-life care preferences with family members and health care providers (HCPs).
METHODS
A total of 149 AYAs aged 18-39 years receiving cancer-directed therapy or treatment for another chronic medical illness were enrolled at seven US sites. Baseline data included prior ACP communication with family members and HCPs and measures of generalized anxiety, ACP anxiety, and social support. Participants critically reviewed each page of VMC and then completed three pages of the document. ACP anxiety was measured again immediately after the completion of VMC pages. One month later, participants repeated anxiety and social support measures and were asked if they shared what they had completed in VMC with a family member or HCP.
RESULTS
At baseline, 50.3% of participants reported that they previously had a conversation about EoL preferences with a family member; 19.5% with an HCP. One month later, 65.1% had subsequently shared what they wrote in VMC with a family member; 8.9% shared with an HCP. Most (88.6%) reported they would not have had this conversation if not participating in the study. No significant changes occurred in social support. There was an immediate drop in anxiety about EoL planning after reviewing VMC which persisted at 1 month. Generalized anxiety was also significantly lower 1 month after reviewing VMC.
SIGNIFICANCE OF RESULTS
Having a document specifically created for AYAs to guide ACP planning can decrease anxiety and increase communication with family members but not necessarily with HCPs. Future research should examine ways ACP can be introduced more consistently to this young population to allow their preferences for care to be heard, respected, and honored, particularly by their healthcare providers.
目的
确定使用正式工具（VMC）进行预先护理计划（ACP）是否会减轻青少年和年轻人（AYAs）对 ACP 的焦虑，并增加与家庭成员和医疗保健提供者（HCPs）关于临终关怀偏好的社会支持和沟通。
方法
共有 149 名年龄在 18-39 岁之间的 AYAs 在七个美国地点接受癌症定向治疗或另一种慢性疾病的治疗。基线数据包括之前与家庭成员和 HCP 进行的 ACP 沟通，以及一般焦虑、ACP 焦虑和社会支持的测量。参与者仔细审查了 VMC 的每一页，然后完成了三页的文件。在完成 VMC 页面后立即再次测量 ACP 焦虑。一个月后，参与者重复了焦虑和社会支持的测量，并被问及他们是否与家庭成员或 HCP 分享了他们在 VMC 中完成的内容。
结果
在基线时，50.3%的参与者报告说他们之前与家庭成员讨论过 EoL 偏好；19.5%与 HCP 讨论过。一个月后，65.1%的人随后与家庭成员分享了他们在 VMC 中写的内容；8.9%与 HCP 分享。大多数（88.6%）人表示，如果不参与研究，他们不会进行这次对话。社会支持没有显著变化。在审查 VMC 后，对 EoL 规划的焦虑立即下降，并在 1 个月后持续下降。在审查 VMC 后，一般焦虑也显著降低。
结果的意义
为 AYAs 专门创建一份指导 ACP 规划的文件可以减轻焦虑并增加与家庭成员的沟通，但不一定与 HCPs 沟通。未来的研究应该研究如何更一致地向这一年轻人群引入 ACP，以使其护理偏好得到倾听、尊重和尊重，特别是得到他们的医疗保健提供者的尊重。
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