提高对可能发生之事的认知并做好准备：老年病房中体弱居家老年人的亲属参与预立医疗照护计划的经历
Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units.
作者信息
Hermansen Karin Berg, Alnes Rigmor Einang, Lereim Saevareid Trygve Johannes, Pedersen Reidar, Westbye Siri Faerden, Romøren Maria, Midtbust May Helen
机构信息
Department of Health Sciences, Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Box 1517, Aalesund, 6025, Norway.
Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Box 1130 Blindern, Oslo, 0318, Norway.
出版信息
BMC Health Serv Res. 2025 Mar 27;25(1):454. doi: 10.1186/s12913-025-12609-9.
BACKGROUND
Acutely ill and frail older adults and their next of kin are often poorly involved in planning of decisions regarding treatment and care during the final phase of life. Although advance care planning is a well-documented tool to strengthen patient autonomy and involve next of kin, it remains underused in hospital settings. We present a qualitative sub-study embedded in a cluster-randomized controlled trial, whose purpose was to implement advance care planning in Norwegian geriatric units. Frail, home dwelling older adults acutely admitted to geriatric hospital units were invited to participate in advance care planning together with their next of kin. The aim of this study was to explore next of kin experiences of advance care planning.
METHODS
The study has a qualitative design, based on individual semi-structured interviews with 13 next of kin. A purposive sampling was used to select next of kin who had recently participated in advance care planning from five geriatric units in the intervention arm. The analysis was conducted using reflexive thematic analysis by Braun and Clarke.
RESULTS
Four themes were developed from the analysis; (1) Being informed and involved through open communication; (2) Getting prepared for what's to come; (3) The importance of the next of kin role in providing support and facilitation; (4) The need for documentation and collaboration across service levels.
CONCLUSION
Advance care planning appears to provide a sense of security among next of kin by addressing their information needs regarding the patient's prognosis, encouraging discussions on possible courses of action, and clarifying the patient's end-of-life preferences. Next of kin played a crucial role in supporting the patient's autonomy, and they considered the hospital stay as an ideal time for advance care planning. Increased awareness of their role as next of kin seems to enhance agreement and trust when confronting challenging situations and existential questions.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier NTCT05681585. Registered 03.01.23.
背景
在生命的最后阶段，急性病患者和体弱的老年人及其近亲往往很少参与治疗和护理决策的规划。尽管预先护理计划是一种有充分文献记载的增强患者自主权并让近亲参与的工具，但在医院环境中仍未得到充分利用。我们展示了一项嵌入整群随机对照试验的定性子研究，其目的是在挪威老年病房实施预先护理计划。急性入住老年医院病房的体弱居家老年人被邀请与其近亲一起参与预先护理计划。本研究的目的是探索近亲对预先护理计划的体验。
方法
本研究采用定性设计，基于对13名近亲进行的个人半结构化访谈。采用立意抽样法从干预组的五个老年病房中选取最近参与过预先护理计划的近亲。分析采用布劳恩和克拉克的反思性主题分析法。
结果
分析得出四个主题；（1）通过开放沟通获得信息并参与其中；（2）为即将发生的事情做好准备；（3）近亲角色在提供支持和便利方面的重要性；（4）跨服务层面进行记录和协作的必要性。
结论
预先护理计划似乎通过满足近亲对患者预后的信息需求、鼓励就可能的行动方案进行讨论以及明确患者的临终偏好，为近亲提供了一种安全感。近亲在支持患者自主权方面发挥了关键作用，他们认为住院期间是进行预先护理计划的理想时机。当面对具有挑战性的情况和存在性问题时，提高对其近亲角色的认识似乎能增强共识和信任。
试验注册
ClinicalTrials.gov标识符NTCT05681585。于2023年1月3日注册。
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