Wand Anne P F, Karageorge Aspasia, Zeng Yucheng, Browne Roisin, Sands Megan B, Kanareck Daniella, Naganathan Vasi, Meller Anne, Smith Carolyn M, Peisah Carmelle
Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
Psychol Res Behav Manag. 2024 Dec 10;17:4195-4206. doi: 10.2147/PRBM.S496651. eCollection 2024.
To explore mental health clinicians' attitudes, experiences, and perceived barriers regarding Advance Care Planning (ACP) with older people (aged 55+) with schizophrenia/other psychotic illnesses.
Qualitative analysis of focus group interviews with multidisciplinary mental health clinicians from public mental health services in Sydney, Australia. A senior external clinician facilitated online focus groups exploring clinicians' attitudes, experiences, and perceived barriers to ACP using a semi-structured interview guide. Transcripts were recorded and transcribed. N-VIVO was used to organise the data, which were subjected to reflexive thematic analysis grounded with an interpretive description framework.
Fifteen mental health clinicians were recruited. Two overarching themes emerged from thematic analysis of focus group transcripts: (1) It is important, and I want to do it: and (2) But I do not do it because of the complexity. Subthemes in relation to this complexity included: (i) fear of harming; (ii) families and culture; (iii) systemic barriers; (iv) capacity and legal issues; (v) timing; (vi) lack of knowledge and training; (vii) neither prioritised nor embedded in practice.
These clinician-identified attitudes, experiences, and barriers to engagement in ACP with older people with psychotic illnesses highlight avenues of potential intervention to facilitate ACP in this cohort. Given the complexity of issues, clinicians need education and training in ACP combined with clear processes and policies to support practice. Clinician insights should be combined with the perspectives of older consumers with psychotic illnesses and their families to inform implementation of ACP.
探讨心理健康临床医生对于与55岁及以上患有精神分裂症/其他精神病性疾病的老年人进行预先照护计划（ACP）的态度、经历和感知到的障碍。
对来自澳大利亚悉尼公共心理健康服务机构的多学科心理健康临床医生进行焦点小组访谈的定性分析。一位资深外部临床医生使用半结构化访谈指南主持在线焦点小组，探讨临床医生对ACP的态度、经历和感知到的障碍。访谈内容进行了录音和转录。使用N-VIVO软件组织数据，并基于解释性描述框架进行反思性主题分析。
招募了15名心理健康临床医生。焦点小组访谈记录的主题分析得出两个总体主题：（1）这很重要，我也想做：以及（2）但由于复杂性我没有做。与这种复杂性相关的子主题包括：（i）害怕造成伤害；（ii）家庭与文化；（iii）系统障碍；（iv）能力与法律问题；（v）时机；（vi）缺乏知识和培训；（vii）既未被优先考虑也未融入实践。
这些由临床医生识别出的与患有精神病性疾病的老年人进行ACP的态度、经历和障碍，凸显了促进该人群进行ACP的潜在干预途径。鉴于问题的复杂性，临床医生需要接受ACP方面的教育和培训，并结合明确的流程和政策来支持实践。临床医生的见解应与患有精神病性疾病的老年消费者及其家庭的观点相结合，以为ACP的实施提供参考。
