Kastbom Lisa, Olaison Anna, Sverker Annette, Segernäs Anna
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
Primary Health Care Centre, Ekholmen, Linköping, Sweden.
BJGP Open. 2025 Apr 24;9(1). doi: 10.3399/BJGPO.2024.0167. Print 2025 Apr.
Patients in old age often have complex care needs owing to multimorbidity and polypharmacy. This qualitative study is part of a larger ongoing Swedish intervention trial Secure And Focused primary care for older pEople (SAFE), including shorter care agreements based on person-centred patient goals.
To explore, in a primary care setting, the views of older and vulnerable patients on a more systematic, proactive approach to care planning, including establishing and documenting care agreements based on person-centred goals.
DESIGN & SETTING: Individual semi-structured interviews with patients ( = 25) aged >75 years from 12 intervention primary healthcare centres in two counties in Sweden.
Interviews were conducted between June and October 2023. They were digitally recorded and transcribed verbatim. Latent qualitative content analysis was used.
The following three categories, with 10 sub-categories, were found: I would like to live in the present, so why plan ahead? Let me decide versus they know best; and Care agreements usually went unnoticed. The latent theme - The ambivalence of care planning in the fourth age - was created to give a deeper meaning to the content of the categories.
This study emphasises that older, vulnerable persons have varying attitudes towards participation in proactive care planning. This ambivalence may originate from the individual's desire to have their autonomy respected and express future care preferences on the one hand, and to avoid or postpone end-of-life conversations and care planning on the other hand. Patients also expressed a desire to be more actively involved in care planning. Although care agreements have the potential to increase patient involvement in proactive care planning, they often went unnoticed. The conversation itself was essential.
由于多种疾病并存和多种药物治疗，老年患者往往有复杂的护理需求。这项定性研究是正在进行的瑞典一项针对老年人的安全且专注的初级保健（SAFE）大型干预试验的一部分，该试验包括基于以患者为中心的目标制定更简短的护理协议。
在初级保健环境中，探讨老年和弱势患者对更系统、主动的护理计划方法的看法，包括基于以患者为中心的目标制定和记录护理协议。
对瑞典两个县12个干预性初级保健中心的25名75岁以上患者进行个体半结构式访谈。
访谈于2023年6月至10月进行。访谈进行了数字录音并逐字转录。采用潜在定性内容分析法。
发现了以下三个类别，共10个子类别：我想活在当下，为何要提前规划？让我自己决定与他们最了解情况；护理协议通常未被注意到。创建了潜在主题——老年护理规划的矛盾心理，以便更深入地理解这些类别的内容。
本研究强调，老年弱势人群对参与主动护理规划的态度各不相同。这种矛盾心理可能一方面源于个人希望其自主权得到尊重并表达未来护理偏好，另一方面源于避免或推迟临终谈话和护理规划。患者还表示希望更积极地参与护理规划。尽管护理协议有可能增加患者对主动护理规划的参与度，但它们往往未被注意到。谈话本身至关重要。
