Iida Kieko, Ishimaru Mina, Tsujimura Mayuko, Wakasugi Ayumi
Graduate School of Nursing, Chiba University, Chiba, Chiba Prefecture, Japan.
The Chiba University Centre for Evidence Based Practice: A JBI Centre of Excellence, Chiba University, Chiba, Chiba Prefecture, Japan.
JBI Evid Synth. 2025 Jan 1;23(1):69-107. doi: 10.11124/JBIES-23-00221. Epub 2025 Jan 2.
The objective of this review was to examine community-dwelling older people's experiences of advance care planning with health care professionals.
The importance of health care professionals initiating advance care planning for patients has been reported; however, because of the shift from institutionalized to community care, community-dwelling older people have fewer opportunities to discuss these plans with health care professionals compared with older people living in other settings. The timely initiation of advance care planning and sustainable discussions among older people, their families, and community health care professionals is necessary and may improve palliative and end-of-life care.
Studies with participants aged 60 years and older who have experience with advance care planning and live in their own homes in the community were included. We considered qualitative studies and the qualitative component of mixed methods studies published between January 1999 and April 2023 in English or Japanese.
MEDLINE (EBSCOhost), CINAHL (EBSCOhost), Embase, PsycINFO (EBSCOhost), JSTOR, Scopus, Japan Medical Abstract Society, and CiNii were searched for published papers. Google Scholar, ProQuest Dissertations and Theses Global and MedNar were searched for unpublished papers and gray literature. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Findings were pooled using a meta-aggregation approach. The synthesized findings were graded using the ConQual approach for establishing confidence in the output of qualitative research syntheses and presented in a Summary of Findings.
Five studies published between 2017 and 2022 were included in the review. Each study scored between 6 and 8 out of 10 on the JBI critical appraisal checklist for qualitative research. We extracted 28 findings and aggregated them into 7 categories, generating 3 synthesized findings: i) A trusting relationship with health care professionals is essential for older people's decision-making. Health care professionals' attitudes, knowledge, and skills play a role in this, influencing the perceived quality of care; ii) Shared decision-making and patient-centered communication are essential. Older people feel ambiguity toward end-of-life decision and advance care planning, and they want their wishes to be heard in any situation to maintain their autonomy and quality of life; iii) Older people need the appropriate forms and accessible and coordinated care to begin advance care planning.
Qualitative studies on community-dwelling older people's experiences of advance care planning with health care professionals are scarce. The experiences have illustrated that trusting relationships influence people's perception of the quality of care they receive; there is uncertainty about their future; and they have varying feelings or attitudes toward their impending death, including denial and avoidance. This review highlights the need for appropriate forms, and accessible and coordinated care to begin advance care planning; thus, an approach that meets the individual's health and psychosocial status should be selected carefully. Further research is recommended to include older populations from broader geographical and cultural backgrounds, and to assess and evaluate the different advance care planning approaches and their implementation processes among groups of community-dwelling older people with different health and psychosocial statuses.
PROSPERO CRD42020122803.
本综述的目的是研究居家老年人与医护人员进行预先护理计划的经历。
已有报道指出医护人员为患者启动预先护理计划的重要性；然而，由于从机构化护理向社区护理的转变，与生活在其他环境中的老年人相比，居家老年人与医护人员讨论这些计划的机会较少。老年人、其家人和社区医护人员及时启动预先护理计划并进行持续讨论是必要的，这可能会改善姑息治疗和临终关怀。
纳入的研究对象为60岁及以上、有预先护理计划经历且居住在社区自己家中的参与者。我们纳入了1999年1月至2023年4月期间以英文或日文发表的定性研究以及混合方法研究的定性部分。
在MEDLINE（EBSCOhost）、CINAHL（EBSCOhost）、Embase、PsycINFO（EBSCOhost）、JSTOR、Scopus、日本医学摘要协会和CiNii中检索已发表的论文。在谷歌学术、ProQuest Dissertations and Theses Global和MedNar中检索未发表的论文和灰色文献。由2名独立评审员使用JBI方法和JBI标准化工具进行研究选择、批判性评价、数据提取和数据综合。使用元聚合方法汇总研究结果。使用ConQual方法对综合研究结果进行分级，以确定对定性研究综合结果的可信度，并在研究结果摘要中呈现。
本综述纳入了2017年至2022年期间发表的5项研究。每项研究在JBI定性研究批判性评价清单上的得分在6至8分之间。我们提取了28项研究结果，并将其汇总为7个类别，得出3项综合研究结果：i）与医护人员建立信任关系对老年人的决策至关重要。医护人员的态度、知识和技能在此过程中发挥作用，影响对护理质量的感知；ii）共同决策和以患者为中心的沟通至关重要。老年人对临终决策和预先护理计划感到模糊，他们希望在任何情况下自己的意愿都能被听取以维持自主权和生活质量；iii）老年人需要合适的形式以及可获得且协调的护理来启动预先护理计划。
关于居家老年人与医护人员进行预先护理计划经历的定性研究较少。这些经历表明，信任关系会影响人们对所接受护理质量的认知；他们对未来存在不确定性；并且他们对即将到来的死亡有不同的感受或态度，包括否认和回避。本综述强调需要合适的形式以及可获得且协调的护理来启动预先护理计划；因此，应谨慎选择符合个体健康和心理社会状况的方法。建议进一步开展研究，纳入更广泛地理和文化背景的老年人群体，并评估和评价不同的预先护理计划方法及其在不同健康和心理社会状况的居家老年人群体中的实施过程。
PROSPERO CRD42020122803
