Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
BMJ Open. 2023 Oct 10;13(10):e075969. doi: 10.1136/bmjopen-2023-075969.
The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliative care, nursing and care homes) during the pandemic.
This study employed an overview of reviews design. We searched the MEDLINE, CENTRAL, Web of Science and Embase databases for studies published between 8 December 2019 and 30 July 2023. We used AMSTAR 2 to assess the risk of bias.
We included seven reviews. Common barriers to ACP implementation included visitation restrictions, limited resources and personnel and a lack of coordination among healthcare professionals. In care and nursing homes, barriers included a dearth of palliative care physicians and the psychological burden on facility staff. Using telemedicine for information sharing was a common facilitator across settings. In hospitals, facilitators included short-term training in palliative care and palliative care physicians joining the acute care team. In care and nursing homes, facilitators included ACP education and emotional support for staff.
Visitation restrictions and limited resources during the pandemic posed obstacles; however, the implementation of ACP was further hindered by insufficient staff education on ACP in hospitals and facilities, as well as a scarcity of information sharing at the community level. These pre-existing issues were magnified by the pandemic, drawing attention to their significance. Short-term staff training programmes and immediate information sharing could better enable ACP.
CRD42022351362.
COVID-19 大流行影响了患者、家属和医疗团队进行预先医疗照护计划（ACP）的能力。我们旨在确定并回顾大流行期间不同环境（例如医院、门诊姑息治疗、护理和疗养院）中医疗人员实施 ACP 的障碍和促进因素。
本研究采用综述的综述设计。我们检索了 MEDLINE、CENTRAL、Web of Science 和 Embase 数据库，以获取 2019 年 12 月 8 日至 2023 年 7 月 30 日期间发表的研究。我们使用 AMSTAR 2 评估偏倚风险。
我们纳入了 7 篇综述。ACP 实施的常见障碍包括探视限制、资源和人员有限以及医疗保健专业人员之间缺乏协调。在护理和疗养院中，障碍包括姑息治疗医生的缺乏以及设施工作人员的心理负担。在所有环境中，使用远程医疗进行信息共享是一个常见的促进因素。在医院，促进因素包括姑息治疗的短期培训和姑息治疗医生加入急性护理团队。在护理和疗养院中，促进因素包括 ACP 教育和对工作人员的情感支持。
大流行期间的探视限制和资源有限构成了障碍；然而，医院和设施中对 ACP 的员工教育不足以及社区层面信息共享不足进一步阻碍了 ACP 的实施。这些先前存在的问题在大流行期间被放大，引起了对它们重要性的关注。短期员工培训计划和即时信息共享可以更好地促进 ACP。
PROSPERO 注册号：CRD42022351362。
