Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Department of Nursing, Sijhih Cathay General Hospital, New Taipei City, Taiwan.
PLoS One. 2022 Sep 6;17(9):e0274096. doi: 10.1371/journal.pone.0274096. eCollection 2022.
Advanced care planning (ACP) includes advance directives (AD), which can specify provisions for palliative care and types of life-sustaining treatments for an individual requiring end-of-life (EoL) care. ACP for persons in the early stages of cognitive decline can decrease anxiety and conflict for family members needing to make decisions about EoL-care, which is especially critical for family caregivers (FCGs) if they play a role as a surrogate regarding healthcare decisions. However, ACP for persons with cognitive impairment (PWCIs) is often overlooked. This study explored the effects of a family-centered ACP intervention on decisions about EoL-care, life-sustaining treatment decisions, and discussions of related topics among PWCIs and FCGs. The study was conducted in outpatient clinics of regional teaching hospitals in northern Taiwan. Participants were dyads consisting of persons diagnosed with mild cognitive impairment or mild dementia and their FCGs. The family-centered ACP intervention was provided by an ACP-trained senior registered nurse. A one-group, pretest-posttest design was used to evaluate the effect of the intervention on 44 dyads. Four structured questionnaires collected data regarding familiarity with ACP, intention to engage in ACP, participation in personal discussions between the dyads about ACP, and consistency between PWCIs and FCGs for decisions about life-sustaining treatments at EoL. Paired t, Kappa, and McNemar tests were used to compare differences between pre-intervention data (pretest) and post-intervention data (posttest). There were significant increases in familiarity with ACP, components of ACP, and the number of topics PWCIs and FCGs personally discussed surrounding EoL-care decisions. There was no change for either group in wanting to have a formal ACP consultation and only modest increases in consistency between PWCIs and FCGs for life-sustaining treatment decisions after completion of the family-centered ACP intervention. Clinicians caring for PWCIs should incorporate family-centered ACP interventions and support ongoing discussions about life-sustaining medical treatments to ensure their preferences regarding EoL-care are respected. The accessibility and availability of consultations about ACP should also be provided.
高级医疗照护计划（ACP）包括预先指示（AD），可以指定终末期（EoL）医疗照护的缓和医疗和各种维持生命治疗方案。对于需要为 EoL 医疗照护做出决策的家庭成员来说，为认知能力下降早期阶段的个体进行 ACP 可以减轻他们的焦虑和冲突，这对于作为医疗决策代理人的家庭照顾者（FCG）来说尤其重要。然而，患有认知障碍（PWCIs）的个体的 ACP 往往被忽视。本研究旨在探讨以家庭为中心的 ACP 干预对 PWCIs 和 FCGs 有关 EoL 医疗照护、维持生命治疗决策以及相关主题讨论的影响。研究在台湾北部地区教学医院的门诊诊所进行。研究对象为由轻度认知障碍或轻度痴呆症患者及其 FCG 组成的个体对。由接受过 ACP 培训的高级注册护士提供以家庭为中心的 ACP 干预。采用单组前后测设计评估干预对 44 对个体对的影响。使用四个结构化问卷收集有关对 ACP 的熟悉程度、进行 ACP 的意愿、个体对 ACP 的讨论参与情况以及在 EoL 时 PWCIs 和 FCGs 对维持生命治疗决策的一致性的信息。使用配对 t 检验、Kappa 检验和 McNemar 检验比较干预前后数据（前测和后测）的差异。研究发现，对 ACP 的熟悉程度、ACP 的组成部分以及 PWCIs 和 FCGs 个人讨论的 EoL 照护决策相关主题数量均显著增加。对于任何一组，想要进行正式 ACP 咨询的意愿均无变化，仅在完成以家庭为中心的 ACP 干预后，PWCIs 和 FCGs 对维持生命治疗决策的一致性略有增加。照顾 PWCIs 的临床医生应将以家庭为中心的 ACP 干预纳入其中，并支持有关维持生命的医疗治疗的持续讨论，以确保他们在 EoL 照护方面的偏好得到尊重。还应提供有关 ACP 咨询的可及性和可用性。
