Advance Care Planning in Community-Dwelling Patients With Dementia
Advance Care Planning in Community-Dwelling Patients With Dementia
复制标题
DOI：
10.1016/j.jpainsymman.2017.12.473
复制
发表时间：
2018-04-01
影响因子：
4.7
通讯作者：
Mitchell, Susan L.
中科院分区：
文献类型：
--
作者：
Givens, Jane L.;Sudore, Rebecca L.;Mitchell, Susan L.
上下文对社区痴呆患者的预先护理计划（ACP）知之甚少。描述痴呆患者ACP的各个方面，并检查ACP与医疗保健代理人（HCP）对患者疾病的接受程度之间的关系。对来自波士顿7家老年和记忆障碍门诊的62名HCP痴呆患者（N = 14名轻度，N = 48名中度/重度）进行了横断面观察性调查。ACP的方面包括HCP报告患者对未来护理水平的偏好，与HCP和医生就护理偏好进行沟通，以及共同决策的代理准备。ACP和HCP接受度与患者疾病之间的关系采用癌症经历量表中的平和、平静和接受度子量表进行检查。11%的代理人认为患者需要延长生命的治疗，31%的代理人认为患者需要有时间限制的治愈性治疗试验，47%的代理人认为患者需要舒适的护理。31%的患者报告称，患者已与医生就护理偏好进行了沟通，77%的患者与HCP进行了沟通。44%的HCP希望与患者就护理偏好进行更多讨论。HCP与患者讨论护理偏好与更大程度地接受患者的疾病相关（P = 0.004）。我们的研究结果支持患者和代理人之间需要更多的ACP讨论。关于护理目标的讨论可能会通过提供符合患者意愿的护理而使患者受益，HCP也会更好地接受患者的疾病。(C)2017年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Little is known about advance care planning (ACP) among community-dwelling patients with dementia.Objectives. To describe aspects of ACP among patients with dementia and examine the association between ACP and health care proxy (HCP) acceptance of patients' illness.Methods. Cross-sectional observational survey of 62 HCPs of patients with dementia (N = 14 mild, N = 48 moderate/ severe), from seven outpatient geriatric and memory disorder clinics in Boston. Aspects of ACP included HCP's report of patients' preferences for level of future care, communication with HCP and physician regarding care preferences, and proxy preparedness for shared decision making. The association between ACP and HCP acceptance with patients' illness was examined using the Peace, Equanimity, and Acceptance subscale of the Cancer Experience Scale.Results. Eleven percent of proxies believed that the patient would want life-prolonging treatment, 31% a time-limited trial of curative treatment, and 47% comfort-focused care. Thirty-one percent reported that the patient had communicated with their physician regarding preferences for care, and 77% had communicated with the HCP. Forty-four percent of HCPs wanted more discussion with the patient regarding care preferences. The HCP having discussed care preferences with the patient was associated with greater acceptance of the patient's illness (P = 0.004).Conclusion. Our findings support need for greater ACP discussions between patients and proxies. Discussions regarding goals of care are likely to benefit patients through delivery of care congruent with their wishes and HCPs in terms of greater acceptance of patients' illness. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.