Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
BMC Health Serv Res. 2024 Jan 10;24(1):51. doi: 10.1186/s12913-023-10491-x.
Advance care planning (ACP) is becoming increasingly important in medical care. Some suggest standardized approaches to initiate ACP with all older adults. However, the idea of patient-centered care suggests more nuanced approaches tailored to individual older adults' needs. This study investigated how older adults with different views and needs about ACP can be approached in an adequate and most beneficial way by health care professionals.
We used questionnaires, interviews, focus groups and informal conversations with older adults, living in their own homes, who volunteered to take part in our research. The research was participatory as we collaborated closely with practice partners and we used the obtained findings immediately and continuously to inform the next steps of our research throughout the process.
We identified three subgroups of older adults with differential needs regarding ACP-related activities: The first group avoids talking about their needs and wishes for care towards the end of life. These older people benefit from activities, which aim at motivating them to concern themselves with ACP-related topics. The second group consists of older adults who are in principle open for ACP-conversations but do not initiate these themselves. This group either trusts their next-of-kin or their healthcare professional to act in accordance with their wishes or does not bring up the topic in order to avoid confronting relevant others with possibly unpleasant topics. This group of people benefits from information about ACP and from healthcare professionals initiating the ACP process. The third group of older people initiates the ACP process themselves, gathers information, and takes the necessary steps for ACP. With this group it remains relevant to check carefully whether they have indeed taken all relevant steps and shared the information with all relevant involved care institutions and relatives.
We propose a model to simplify adjustments of ACP to individuals' needs. Our suggested approach might contribute to increasing the motivation of older people to engage in ACP conversations if these are more closely related to their own needs. Further, it might also contribute to simplifying the individual shaping of the ACP process for healthcare professionals as our suggested model offers clear guidance for approaching different types of older people in different ways. The suggested approach may in future be used for training health care professionals in the conduct of ACP conversations.
预先医疗照护计划（ACP）在医疗保健中变得越来越重要。有人建议对所有老年人采用标准化方法启动 ACP。然而，以患者为中心的护理理念表明，需要针对个体老年人的需求采用更细致的方法。本研究探讨了如何以适当和最有益的方式为具有不同 ACP 观点和需求的老年人提供医疗保健专业人员的服务。
我们使用问卷、访谈、焦点小组和与自愿参与我们研究的、居住在自己家中的老年人进行的非正式对话收集数据。本研究是参与式的，因为我们与实践伙伴密切合作，并且在整个过程中，我们立即并持续地使用所获得的研究结果为下一步研究提供信息。
我们确定了具有不同 ACP 相关活动需求的三组老年人：第一组老年人避免谈论他们在生命末期的护理需求和意愿。这些老年人从旨在激励他们关注 ACP 相关话题的活动中受益。第二组老年人原则上对 ACP 对话持开放态度，但不主动发起这些对话。这组人要么信任他们的近亲或医疗保健专业人员会按照他们的意愿行事，要么避免提出这个话题，以免与相关人员讨论可能令人不快的话题。这组人受益于有关 ACP 的信息和医疗保健专业人员启动 ACP 流程。第三组老年人主动启动 ACP 流程，收集信息，并为 ACP 采取必要的步骤。对于这组人，仍然需要仔细检查他们是否确实采取了所有相关步骤，并与所有相关的护理机构和亲属分享了信息。
我们提出了一个简化 ACP 以适应个人需求的模型。如果 ACP 对话更紧密地与老年人的自身需求相关，我们建议的方法可能有助于提高老年人参与 ACP 对话的积极性。此外，这也可能有助于简化医疗保健专业人员对 ACP 流程的个性化塑造，因为我们建议的模型为以不同方式接近不同类型的老年人提供了明确的指导。在未来，该方法可用于培训医疗保健专业人员进行 ACP 对话。
