Li Yingjie, Xiong Xiaoyun, Wang Huiwen, Chen Lu, Wu Rui, Liu Si, Chen Hua, Zhang Meijun, Xiang Qin
The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, China.
Worldviews Evid Based Nurs. 2025 Aug;22(4):e70070. doi: 10.1111/wvn.70070.
Chronic heart failure (CHF) is a progressive life-limiting condition that necessitates early implementation of advance care planning (ACP). However, patients and caregivers encounter emotional, informational, and cultural barriers to effective ACP engagement. This meta-synthesis consolidates qualitative evidence to deepen our understanding of ACP practices in CHF care.
This study aimed to explore experiences of CHF patients and their caregivers in ACP, which is defined as a proactive decision-making process to establish future treatment plans based on patients' values. The study also aimed to identify barriers and facilitators influencing ACP decisions and assess the impact of flexible, personalized ACP approaches on care quality.
Using qualitative meta-synthesis, we analyzed 10 qualitative studies on CHF patients' and caregivers' ACP experiences. Data were thematically synthesized to identify emotional, relational, and practical factors that influence engagement in ACP.
Three themes emerged: (1) heart failure patients and caregivers face difficulties in ACP (difficulties from patients, difficulties from the family, and difficulties from the society), (2) multidimensional drivers and impacts of ACP (advance care planning drivers, acceptance and implementation of ACP, emotions and effects of ACP), (3) flexible, personalized ACP delivers tangible benefits (timing and effectiveness of ACP discussions, patients and caregivers have personalized needs for ACP, and patients and caregivers affirm ACP benefits).
ACP plays a critical role in improving end-of-life care quality and reducing emotional and decision-making burdens on caregivers. Flexible and personalized ACP strategies supported by trained healthcare professionals more effectively meet the unique needs of patients and families. To overcome persistent barriers and promote broader ACP adoption, healthcare systems should prioritize provider communication training, ACP education, and support systems tailored to diverse cultural contexts.
慢性心力衰竭（CHF）是一种渐进性的、危及生命的疾病，需要尽早实施预先护理计划（ACP）。然而，患者和护理人员在有效参与ACP方面面临情感、信息和文化障碍。这项元综合分析整合了定性证据，以加深我们对CHF护理中ACP实践的理解。
本研究旨在探索CHF患者及其护理人员在ACP方面的经历，ACP被定义为一个基于患者价值观建立未来治疗计划的主动决策过程。该研究还旨在确定影响ACP决策的障碍和促进因素，并评估灵活、个性化的ACP方法对护理质量的影响。
我们采用定性元综合分析方法，分析了10项关于CHF患者及其护理人员ACP经历的定性研究。对数据进行主题综合分析，以确定影响参与ACP的情感、关系和实际因素。
出现了三个主题：（1）心力衰竭患者和护理人员在ACP方面面临困难（患者方面的困难、家庭方面的困难和社会方面的困难），（2）ACP的多维度驱动因素和影响（预先护理计划驱动因素、ACP的接受和实施、ACP的情感和效果），（3）灵活、个性化的ACP带来切实益处（ACP讨论的时机和效果、患者和护理人员对ACP有个性化需求、患者和护理人员肯定ACP的益处）。
ACP在提高临终护理质量和减轻护理人员的情感及决策负担方面发挥着关键作用。由训练有素的医疗保健专业人员支持的灵活、个性化的ACP策略能更有效地满足患者和家庭的独特需求。为了克服持续存在的障碍并促进更广泛地采用ACP，医疗保健系统应优先开展提供者沟通培训、ACP教育以及针对不同文化背景量身定制的支持系统。
