Kullenberg Helena, Helgesson Gert, Juth Niklas, Lindblad Anna
Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden.
J Aging Res. 2024 Nov 29;2024:2104985. doi: 10.1155/jare/2104985. eCollection 2024.
Person-centered care emphasizes patient choice and autonomy and is considered an important means for improving the quality of care and quality of life for older adults with multiple chronic conditions and functional limitations. In implementing person-centered care, goals of care based on the patient's preferences are considered fundamental. Psychiatry is generally practiced in a curative paradigm, and little is known about the goals of care in geriatric psychiatric settings. In this study, goals of care as documented in care plans and medical records in geriatric psychiatric outpatient care have been explored, with a special focus on the end of life. This study was based on a descriptive qualitative content analysis of medical records of patients enrolled at an outpatient clinic for geriatric psychiatry at the time of death. It was complemented by a basic quantitative analysis of patient characteristics. A total of 66 medical records were included, with a male/female ratio of 41/59% and a mean age of 83 years (66-104 years). Among psychiatric diagnoses, depression predominated. The dataset was generally limited, and clearly defined goals of care were sparsely presented. Therefore, the included medical records were analyzed twice: first regarding goals of care and second regarding patient wishes and requests. In both cases, the highest level of abstraction in terms of themes was achieved. Analysis of goals of care resulted in the themes patient well-being and care arrangements. Analysis of patient wishes resulted in the themes active patienthood and living and being. Goals of care were often disease-oriented, focusing on recovery or symptom management, whereas analysis of patients' wishes revealed personal goals other than remission, including outspoken existential needs. The results call for further research on the interplay between person-centered care and the goal-planning process and point to the potential of a palliative approach in geriatric psychiatric care involving patients with complex comorbidities and multilevel needs.
以患者为中心的护理强调患者的选择和自主权，被认为是提高患有多种慢性病和功能受限的老年人护理质量和生活质量的重要手段。在实施以患者为中心的护理时，基于患者偏好的护理目标被视为根本。精神病学通常以治疗模式开展，而对于老年精神病学环境中的护理目标知之甚少。在本研究中，我们探讨了老年精神病门诊护理计划和病历中记录的护理目标，特别关注生命末期。本研究基于对老年精神病门诊患者死亡时病历的描述性定性内容分析，并辅以患者特征的基本定量分析。共纳入66份病历，男女比例为41/59%，平均年龄83岁（66 - 104岁）。在精神疾病诊断中，抑郁症占主导。数据集通常有限，明确的护理目标很少出现。因此，对纳入的病历进行了两次分析：第一次关于护理目标，第二次关于患者的愿望和请求。在这两种情况下，都实现了主题层面的最高抽象水平。对护理目标的分析得出了患者福祉和护理安排两个主题。对患者愿望的分析得出了积极患者身份以及生活与存在两个主题。护理目标通常以疾病为导向，侧重于康复或症状管理，而对患者愿望的分析揭示了除缓解之外的个人目标，包括明确表达的存在需求。研究结果呼吁进一步研究以患者为中心的护理与目标规划过程之间的相互作用，并指出姑息治疗方法在涉及复杂合并症和多层次需求患者的老年精神病护理中的潜力。
