Faculty of Business and Law, St Mary's University, London, England.
Bristol Business School, University of the West of England, Bristol, England.
PLoS One. 2024 Aug 21;19(8):e0306810. doi: 10.1371/journal.pone.0306810. eCollection 2024.
Advance care planning has been advocated as a way for people to have their wishes recorded and respected in relation to types of treatment and place of care. However, uptake in England remains low.
To examine the views of older, well, adults towards Advance Care Plans (ACPs) and planning for end-of-life care, in order to inform national policy decisions.
A mixed methods approach was adopted, involving individual and mini-group qualitative interviews (n = 76, ages 45-85), followed by a quantitative survey (n = 2294, age 55+). The quantitative sample was based on quotas in age, gender, region, socio-economic grade, and ethnicity, combined with light weighting to ensure the findings were representative of England.
Knowledge and understanding of advance care planning was low, with only 1% of survey respondents reporting they had completed an ACP for themselves. Common reasons for not putting wishes into writing were not wanting/needing to think about it now, the unpredictability of the future, trusting family/friends to make decisions, and financial resources limiting real choice.
Whilst advance care planning is seen as a good idea in theory by older, well, adults living in the community, there is considerable reticence in practice. This raises questions over the current, national policy position in England, on the importance of written ACPs. We propose that policy should instead focus on encouraging ongoing conversations between individuals and all those (potentially) involved in their care, about what is important to them, and on ensuring there are adequate resources in community networks and health and social care systems, to be responsive to changing needs.
预先医疗指示（Advance Care Planning，ACP）被倡导为一种记录和尊重个人治疗类型和护理地点意愿的方式。然而，在英国，这种做法的接受程度仍然很低。
旨在了解健康的老年成年人对预先医疗指示（ACP）和临终关怀规划的看法，以为国家政策决策提供信息。
采用混合方法，包括个人和小组定性访谈（n = 76，年龄 45-85 岁），随后进行定量调查（n = 2294，年龄 55 岁及以上）。定量样本基于年龄、性别、地区、社会经济阶层和种族的配额，结合轻度加权，以确保调查结果能代表英格兰的情况。
对预先医疗指示的了解和认识程度较低，只有 1%的调查受访者表示他们已经为自己制定了 ACP。不将意愿书面化的常见原因包括现在不想/不需要考虑、未来的不可预测性、信任家人/朋友做出决策，以及财务资源限制了实际选择。
虽然预先医疗指示在理论上被社区中健康的老年成年人视为一个好主意，但在实践中却存在相当大的犹豫。这对英格兰目前关于书面 ACP 重要性的国家政策立场提出了质疑。我们建议政策应转而鼓励个人与所有可能参与其护理的人之间进行持续的对话，讨论对他们重要的事情，并确保社区网络和卫生及社会保健系统中有足够的资源，以满足不断变化的需求。
