Wand Anne, Karageorge Aspasia, Zeng Yucheng, Browne Roisin, Sands Meg, Kanareck Daniella, Naganathan Vasi, Meller Anne, Smith Carolyn, Peisah Carmelle
Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
School of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
Eur Geriatr Med. 2025 Mar 14. doi: 10.1007/s41999-025-01161-8.
To examine the attitudes, experiences, and perceived facilitators and barriers to Advance Care Planning (ACP), of older people with schizophrenia and other psychotic illness and their carers.
Older people with a psychotic illness and carers were recruited from public mental health services in Sydney, Australia. Semi-structured interviews to explore attitudes, experiences, and perceived barriers and facilitators to ACP were conducted by an external clinician. Consumers' medical, psychiatric and drug health diagnoses were recorded and they completed cognitive and symptom rating scales. Reflexive thematic analysis was used to analyse the transcripts of interviews, within an interpretive description framework.
Thematic saturation was achieved with 12 consumers and 5 carers. Emergent themes from consumer interviews were (i) 'What is ACP?'; (ii) 'I have not done ACP because…..'; (iii) 'I want to do ACP'; (iv) 'If I was to do ACP I would need..'; and (v) 'Mental health clinicians have the skills to help me with ACP'. Carer themes included (i) 'We do not participate in ACP', (ii) 'I want to participate in ACP', and (iii) 'Key clinician skills are needed'. There was convergence of themes from both groups.
This study demonstrates that older people with a psychotic illness can express views regarding ACP, despite ongoing symptoms of psychosis, cognitive impairment and mild-moderate severity of illness. The emergent themes highlight opportunities to intervene to overcome barriers to ACP, including education for both participant groups and clinicians, practical considerations and the need for all to collaborate, including with primary care.
探讨患有精神分裂症及其他精神病性疾病的老年人及其照护者对预先照护计划（ACP）的态度、经历以及感知到的促进因素和障碍。
从澳大利亚悉尼的公共心理健康服务机构招募患有精神病性疾病的老年人及其照护者。由一名外部临床医生进行半结构化访谈，以探讨对ACP的态度、经历以及感知到的障碍和促进因素。记录消费者的医学、精神科和药物健康诊断情况，并让他们完成认知和症状评定量表。在解释性描述框架内，采用反思性主题分析法对访谈记录进行分析。
对12名消费者和5名照护者进行访谈后实现了主题饱和。消费者访谈中出现的主题有：（i）“什么是ACP？”；（ii）“我没有进行ACP是因为……”；（iii）“我想进行ACP”；（iv）“如果我要进行ACP，我需要……”；以及（v）“心理健康临床医生有能力帮助我进行ACP”。照护者的主题包括：（i）“我们不参与ACP”；（ii）“我想参与ACP”；以及（iii）“需要关键的临床医生技能”。两组的主题有趋同之处。
本研究表明，患有精神病性疾病的老年人尽管存在精神病症状、认知障碍以及疾病的轻中度严重程度，但仍能表达对ACP的看法。新出现的主题突出了进行干预以克服ACP障碍的机会，包括对参与双方和临床医生的教育、实际考虑因素以及所有人（包括与初级保健）合作的必要性。
