Department of Nephrology, Odense University Hospital, Odense C, Denmark.
Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense C, Denmark.
Scand J Caring Sci. 2023 Sep;37(3):812-827. doi: 10.1111/scs.13169. Epub 2023 Apr 17.
Patients with chronic kidney disease and their families strongly request advance care planning. They want it to start early-before treatment decisions are made-and to be an ongoing process during their illness trajectory. Previous international studies show that health care professionals find there to be significant barriers that impact the extent of involvement in advance care planning.
To identify Danish nephrology health care professionals' knowledge and attitudes to advance care planning and the status of current advance care planning practice in Denmark.
An anonymous, cross-sectional survey was administrated online. The questionnaire was developed in Australia and translated and culturally adapted into Danish. Health care professionals were recruited via email lists. In descriptive statistics and multiple ordinal regression, the influence of the respondents' attributes on the extent of involvement in advance care planning was explored, along with the involvement of family, and skills, comfort, barriers and facilitators in relation to advance care planning.
The 207 respondents comprised nephrologists (23%), other physicians (8%), nurses (62%) and other HCPs (7%), of whom 27% had participated in advance care planning training. In total, 66% indicated that they lacked access to material about advance care planning for patients with chronic kidney disease and 46% indicated that the conversations were performed ad hoc. A total of 47% reported that advance care planning was performed well at their workplace. Reported barriers were time, lack of experience and procedure. Training in advance care planning could facilitate the involvement. Nurses were less likely to feel skilled and comfortable in engaging advance care planning, while those with more than 10 years of experience were more likely to feel skilled and comfortable.
Training in advance care planning with patients with chronic kidney disease and their families on both a theoretical and clinical level is important to ensure comfort among health care professionals and to facilitate the extent of involvement. A systematic chronic kidney disease-specific approach is significant, in order to guide the conversations and ensure that advance care planning is conducted to a set standard.
患有慢性肾脏疾病的患者及其家属强烈要求进行预先护理计划。他们希望在治疗决策做出之前尽早开始——并且在疾病发展过程中持续进行。以前的国际研究表明，医疗保健专业人员发现存在重大障碍，影响了他们参与预先护理计划的程度。
确定丹麦肾病学医疗保健专业人员对预先护理计划的知识和态度，以及丹麦当前预先护理计划实践的状况。
进行了一项匿名的横断面调查。调查问卷在澳大利亚开发，并翻译成丹麦语进行文化适应。通过电子邮件列表招募医疗保健专业人员。在描述性统计和多项有序回归中，探讨了受访者属性对预先护理计划参与程度的影响，以及家庭的参与程度，以及与预先护理计划相关的技能、舒适度、障碍和促进因素。
207 名受访者包括肾病学家（23%）、其他医生（8%）、护士（62%）和其他 HCP（7%），其中 27%参加过预先护理计划培训。总共 66%的人表示他们无法获得有关慢性肾脏病患者预先护理计划的材料，46%的人表示这些对话是临时进行的。共有 47%的人报告说，他们的工作场所预先护理计划开展得很好。报告的障碍是时间、缺乏经验和程序。预先护理计划培训可以促进参与。护士在参与预先护理计划方面感到技能和舒适的可能性较小，而具有 10 年以上经验的护士则更有可能感到技能和舒适。
对患有慢性肾脏疾病的患者及其家属进行预先护理计划培训，包括理论和临床培训，对于确保医疗保健专业人员的舒适度并促进参与程度非常重要。采用系统的慢性肾脏病特定方法非常重要，以指导对话并确保预先护理计划按照设定的标准进行。
