Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
NYU School of Medicine, New York, NY, USA.
Am J Hosp Palliat Care. 2024 Aug;41(8):942-951. doi: 10.1177/10499091231200214. Epub 2023 Sep 1.
Advance care planning (ACP), a critical component of quality dementia care, is underutilized due to lack of clinician comfort and the challenging nature of ACP in this context. The Serious Illness Conversation Guide (SICG) is a well-validated clinician-facing tool, developed with patient and clinician input, to facilitate ACP. The aim of this project was to adapt the SICG for dementia for the first time to promote high-quality ACP. This study uses a mixed-methods approach to adapt the SICG tool for use in dementia care. Experts with relevant clinical, ethical, and topical knowledge were interviewed to develop alterations to the SICG for dementia care. Patients and caregivers were shown a mock interview of the adapted SICG for dementia (SICG-D) to elicit feedback. 8 relevant experts were interviewed. Adaptations included topical alterations to make the conversation more applicable to dementia as well as alterations to the structure of the conversation to accommodate the patient-caregiver dyad. Twenty interviews were conducted with 14 patients and 18 caregivers (either together or separately). A thematic content analysis of interview transcripts demonstrated positive impressions of the tool. In anonymous survey results, 94% reported a positive impression of the conversation and 89% endorsed incorporation of the adapted guide into dementia healthcare. This paper presents the SICG-D, an adapted version of the SICG for use in dementia care. This guide leverages the strengths of the SICG to promote values-based ACP conversations and has been adapted to better facilitate patient-caregiver-clinician triadic communication.
预先医疗照护计划（ACP）是优质痴呆症照护的关键组成部分，但由于临床医生的舒适度和 ACP 在这种情况下的挑战性，其利用率很低。严重疾病对话指南（SICG）是一种经过充分验证的面向临床医生的工具，它是在患者和临床医生的投入下开发的，用于促进 ACP。本项目的目的是首次为痴呆症改编 SICG，以促进高质量的 ACP。本研究采用混合方法来改编 SICG 工具，以用于痴呆症护理。具有相关临床、伦理和专题知识的专家接受了采访，以制定针对痴呆症护理的 SICG 修订版。向患者和护理人员展示了改编后的 SICG 用于痴呆症的模拟访谈，以征求反馈。采访了 8 名相关专家。改编包括针对主题的更改，以使对话更适用于痴呆症，以及对话结构的更改，以适应患者-护理人员二人组。对 14 名患者和 18 名护理人员（单独或一起）进行了 20 次访谈。对访谈记录的主题内容分析表明，人们对该工具的印象积极。在匿名调查结果中，94%的人对对话印象积极，89%的人赞成将改编后的指南纳入痴呆症医疗保健。本文介绍了 SICG-D，这是一种针对痴呆症护理的 SICG 改编版。该指南利用了 SICG 的优势，促进了基于价值观的 ACP 对话，并进行了改编，以更好地促进患者-护理人员-临床医生三方沟通。
