Sterie Anca-Cristina, Bernard Mathieu, Jox Ralf J, Rubli Truchard Eve
Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Chair of Palliative Psychology, Service of Palliative and Supportive Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Palliat Med. 2025 Jun;39(6):700-708. doi: 10.1177/02692163251331168. Epub 2025 Apr 25.
During advance care planning, individuals can benefit from the support of a healthcare professional to navigate the intricacies of decision-making. There are specific roles to be played at each level of the process. Evidence is lacking about how professionals understand their role when conducting advance care planning conversations.
To explore how professionals perceive, define and describe their role when conducting advance care planning conversations.
We conducted this exploratory cross-sectional study in Switzerland from November 2019 to June 2020 by using semi-structured interviews, which were transcribed and thematically analysed with an inductive approach.
Fourteen professionals having received a training on advance care planning in Switzerland.
We identified three themes: (1) role typology; (2) individual-centred and (3) professional-centred aspects related to role ascription. Roles that professionals undertake were aggregated in two overarching categories, 'facilitators' and 'counsellors', according to whether they prioritise individual's capacity to decide for themselves or their need to receive guidance towards a particular decision. In practice, roles fluctuate between these categories, according to the individuals (to what extent they are informed and eager to engage in autonomous decisions, their communication capacity and desires) or the professional (main profession and involvement in the person's care plan).
Advance care planning requires professionals to be very adaptable and flexible in order to identify the role that they can play in each situation. Training needs to take into consideration this complexity and address it explicitly.
在预先护理计划制定过程中，个人可以从医疗保健专业人员的支持中受益，以应对决策的复杂性。在该过程的每个层面都有特定的角色要发挥。关于专业人员在进行预先护理计划对话时如何理解自己的角色，目前缺乏证据。
探讨专业人员在进行预先护理计划对话时如何看待、定义和描述自己的角色。
我们于2019年11月至2020年6月在瑞士进行了这项探索性横断面研究，采用半结构化访谈，对访谈内容进行转录，并采用归纳法进行主题分析。
14名在瑞士接受过预先护理计划培训的专业人员。
我们确定了三个主题：（1）角色类型学；（2）以个人为中心和（3）与角色归属相关的以专业为中心的方面。根据专业人员是优先考虑个人自己做决定的能力还是他们在特定决定上接受指导的需求，他们所承担的角色归纳为两个总体类别，即“促进者”和“顾问”。在实践中，根据个人情况（他们了解信息的程度以及参与自主决策的意愿、沟通能力和愿望）或专业人员情况（主要职业以及在个人护理计划中的参与程度），角色会在这些类别之间波动。
预先护理计划要求专业人员非常具有适应性和灵活性，以便确定他们在每种情况下可以发挥的角色。培训需要考虑到这种复杂性并明确加以解决。
