van Lummel Eline Vtj, Maats Emma Pe, Kenswil Elena P, Tjan Dave Ht, van Delden Johannes Jm, Milota Megan
Department of Intensive Care, Gelderse Vallei Hospital, Ede, Netherlands; Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Intensive Care, Gelderse Vallei Hospital, Ede, Netherlands; Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Patient Educ Couns. 2025 Sep;138:109214. doi: 10.1016/j.pec.2025.109214. Epub 2025 Jun 6.
The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention was developed to facilitate early initiated and structured advance care planning (ACP) at outpatient clinics. This study explores stakeholder evaluations of MUTUAL after its implementation.
A sequential explanatory mixed-methods study was conducted at seven outpatient clinics at one non-academic Dutch hospital. Patients, nurses, and physicians completed questionnaires after participating in an ACP conversation. Quantitative analysis of the questionnaire results was supplemented by a qualitative analysis of open comments, and semi-structured interviews were conducted with patients and proxies.
For 216 ACP conversations, responses were received from 121 patients (response rate 57.9 %) and from 136 nurses and 116 physicians (response rates 65.1 % and 55.5 %). Overall, 80.1 % of conversations were evaluated by at least one stakeholder. All stakeholders rated the ACP conversations as worthwhile (4.6-4.8 out of 5) and expressed satisfaction (scores of 8.6, 7.8, and 8.3 out of 10 for patients, nurses, and physicians, respectively). Three themes were identified. First, we found a diversity of patient paths within the ACP process. MUTUAL facilitated reflection and open dialog at various stages, leading to valuable discussions despite sometimes confrontational end-of-life topics. Second, stakeholders had varying perspectives on what makes the ACP conversation valuable. Some HCPs emphasize the importance of making treatment decisions. Others value the opportunity to address patient concerns even without changes to the treatment decisions of the patient. Third, having time and a structured setting outside regular outpatient consultations fostered trust and openness; HCPs' empathy and expertise were appreciated, seemingly regardless of prior established relationships.
MUTUAL was positively received by stakeholders, even when evoking mixed emotions. By encouraging broader discussions beyond immediate treatment decisions, the intervention promoted reflection, reassurance, and ongoing conversations. Findings support an adaptable, multi-stakeholder ACP approach in which HCPs act as guiding partners for patients during their (chronic) illness journeys.
多学科及时开展的预立医疗计划（MUTUAL）干预措施旨在促进门诊诊所早期启动并构建预立医疗计划（ACP）。本研究探讨了MUTUAL实施后利益相关者的评价。
在一家非学术性荷兰医院的七个门诊诊所进行了一项顺序解释性混合方法研究。患者、护士和医生在参与一次ACP谈话后完成问卷。对问卷结果的定量分析辅以对开放式评论的定性分析，并对患者及其代理人进行了半结构化访谈。
对于216次ACP谈话，收到了121名患者的回复（回复率57.9%）以及136名护士和116名医生的回复（回复率分别为65.1%和55.5%）。总体而言，80.1%的谈话至少得到了一名利益相关者的评价。所有利益相关者都认为ACP谈话是有价值的（5分制中得4.6 - 4.8分），并表示满意（患者、护士和医生的评分分别为10分制中的8.6分、7.8分和8.3分）。确定了三个主题。首先，我们发现在ACP过程中患者路径具有多样性。MUTUAL在各个阶段促进了反思和开放对话，尽管有时涉及临终话题且具有对抗性，但仍引发了有价值的讨论。其次，利益相关者对于使ACP谈话有价值的因素有不同看法。一些医疗保健人员强调做出治疗决策的重要性。其他人则重视即使不改变患者的治疗决策，也有机会解决患者的担忧。第三，在常规门诊咨询之外拥有时间和结构化的环境促进了信任和开放；医疗保健人员的同理心和专业知识受到赞赏，似乎与之前建立的关系无关。
利益相关者对MUTUAL给予了积极评价，即使引发了复杂的情绪。通过鼓励超越即时治疗决策的更广泛讨论，该干预措施促进了反思、安心和持续对话。研究结果支持一种适应性强的多利益相关者ACP方法，其中医疗保健人员在患者的（慢性）疾病过程中作为指导伙伴。
