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重新构想和重塑预先医疗指示。

Reimagining and rebranding advance care planning.

机构信息

Duke-NUS Medical School, Lien Centre for Palliative Care, Program in Health Services and Systems Research, 8 College Road Singapore 169857.

出版信息

Age Ageing. 2024 Oct 1;53(10). doi: 10.1093/ageing/afae233.

Abstract

Advance care planning (ACP) has traditionally aimed at ensuring that patients' end-of-life (EOL) wishes are understood and respected. However, recent literature raises concerns about its effectiveness, with many trials indicating that ACP does not significantly improve goal-concordant care, enhance quality of life or reduce healthcare costs. This is because patients' future decisions are influenced by their transient preferences due to projection bias. To remain relevant, ACP requires a radical shift in perspective, implementation and branding. First, ACP's mission must be redefined with a focus on: Educate, Share and Prepare. This perspective emphasises ongoing conversations about patient health and illness, sharing of patients' current values and goals of care and preparation for the future, rather than making definitive future decisions. Second, ACP should be integrated into routine care, normalising these discussions. Simplifying ACP processes and shifting incentives to support shared responsibility among stakeholders can enhance integration. Last, rebranding ACP as 'Advance Care Preparation' can clarify its purpose, distinguishing it from EOL planning and increasing its uptake. This rebranding ensures that ACP meets the evolving needs of patients and their families, ultimately enhancing the quality of care and patient satisfaction. These changes in perspective, implementation and branding can transform ACP into a valuable tool for delivering compassionate, patient-centred healthcare, making it relevant to all individuals.

摘要

预先医疗照护计划(ACP)传统上旨在确保患者的临终意愿得到理解和尊重。然而,最近的文献对其有效性提出了担忧,许多试验表明,ACP 并没有显著改善目标一致的护理、提高生活质量或降低医疗保健成本。这是因为患者未来的决策受到投射偏见导致的短暂偏好的影响。为了保持相关性,ACP 需要在观点、实施和品牌方面进行彻底转变。首先,必须重新定义 ACP 的使命,重点是:教育、分享和准备。这种观点强调了关于患者健康和疾病的持续对话,分享患者当前的价值观和护理目标,以及为未来做准备,而不是做出明确的未来决策。其次,应将 ACP 纳入常规护理中,使这些讨论正常化。简化 ACP 流程并调整激励措施以支持利益相关者共同承担责任,可以增强整合。最后,将 ACP 重新命名为“预先医疗照护准备”可以澄清其目的,将其与临终规划区分开来,并提高其接受度。这种重新定位确保了 ACP 满足患者及其家属不断变化的需求,最终提高了护理质量和患者满意度。这些观点、实施和品牌的变化可以将 ACP 转变为提供富有同情心、以患者为中心的医疗保健的有价值工具,使其适用于所有个人。

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本文引用的文献

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Advance care planning: It is time to rethink our goals.预先护理计划:是时候重新思考我们的目标了。
J Am Geriatr Soc. 2023 Dec;71(12):3963-3966. doi: 10.1111/jgs.18511. Epub 2023 Jul 31.
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What's Wrong With Advance Care Planning?预先护理规划存在什么问题?
JAMA. 2021 Oct 26;326(16):1575-1576. doi: 10.1001/jama.2021.16430.
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Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus.定义成功的预先医疗照护计划的结果:德尔菲小组共识。
J Pain Symptom Manage. 2018 Feb;55(2):245-255.e8. doi: 10.1016/j.jpainsymman.2017.08.025. Epub 2017 Sep 1.

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