Huepenbecker Sarah P, Lewis Sophia, Valentine Mark C, Palisoul Marguerite L, Thaker Premal H, Hagemann Andrea R, McCourt Carolyn K, Fuh Katherine C, Powell Matthew A, Mutch David G, Kuroki Lindsay M
Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States.
Washington University School of Medicine, St. Louis, MO, United States.
Gynecol Oncol Rep. 2022 Aug 5;43:101060. doi: 10.1016/j.gore.2022.101060. eCollection 2022 Oct.
Assess and improve advance care planning (ACP) awareness and uptake among gynecologic oncology patients.
Using a quality improvement Plan-Do-Check-Act framework, we completed a single institution needs assessment and intervention. The needs assessment was a 26-question survey assessing baseline ACP knowledge and preferences of gynecologic oncology patients. We used this survey to implement an outpatient intervention in which patients were offered ACP resources (pamphlet, discussion with their gynecologic oncologist, and/or social work referral). We conducted a post-intervention survey among patients who had and had not received ACP resource(s) to assess whether our intervention increased ACP knowledge, discussions, or uptake.
Among 106 patients surveyed in the needs assessment, 33 % had ACP documents, 26 % had discussed ACP with a physician, and 82 % thought discussing ACP was important. The majority preferred these conversations in the outpatient setting (52 %) with their gynecologic oncologist (80 %) instead of nurses or trainees. In the intervention, 526 patients were offered ACP resources. Compared to women who did not receive resources (n = 324), patients who received ACP resource(s) (n = 202) were more likely to have ACP discussions with their gynecologic oncologist (38 % vs 68 %, = 0.001) and had greater proficiency regarding how to create ACP documents (median score 5/10 vs 8/10, = 0.048), although they were no more likely to have ACP documented in their electronic medical record (27 % vs 9 %, p = 0.08).
ACP uptake among gynecologic oncology patients is low, but ACP discussions with an oncologist during outpatient visits are important to patients and improve their knowledge regarding completing ACP documents.
评估并提高妇科肿瘤患者对预立医疗计划（ACP）的认知度及接受度。
我们采用质量改进的计划-实施-检查-行动框架，完成了一项单机构需求评估及干预措施。需求评估是一项包含26个问题的调查，用以评估妇科肿瘤患者的ACP基线知识及偏好。我们利用此项调查实施了一项门诊干预措施，为患者提供ACP资源（宣传册、与妇科肿瘤医生讨论及/或转介至社会工作服务）。我们对接受和未接受ACP资源的患者进行了干预后调查，以评估我们的干预措施是否提高了患者对ACP的认知、讨论或接受程度。
在需求评估中接受调查的106例患者里，33%拥有ACP文件，26%曾与医生讨论过ACP，82%认为讨论ACP很重要。大多数患者倾向于在门诊环境中（52%）与妇科肿瘤医生（80%）而非护士或实习生进行这些对话。在干预措施中，526例患者获得了ACP资源。与未获得资源的女性（n = 324）相比，获得ACP资源的患者（n = 202）更有可能与妇科肿瘤医生进行ACP讨论（38%对68%，P = 0.001），并且在如何创建ACP文件方面有更高的熟练度（中位数得分5/10对8/10，P = 0.048），尽管他们在电子病历中记录ACP的可能性并没有更高（27%对9%，P = 0.08）。
妇科肿瘤患者对ACP的接受度较低，但在门诊就诊期间与肿瘤医生进行ACP讨论对患者很重要，并能提高他们关于完成ACP文件的知识水平。
