Prognosis conversations in advanced liver disease: A qualitative interview study with health professionals and patients.
Prognosis conversations in advanced liver disease: A qualitative interview study with health professionals and patients.
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DOI：
10.1371/journal.pone.0263874
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Naik AD
中科院分区：
文献类型：
--
作者：
Arney J;Gray C;Clark JA;Smith D;Swank A;Matlock DD;Melcher J;Kanwal F;Naik AD
晚期肝病（AdvLD）很常见，具有致病性，且死亡可能性较高。患者可能不完全了解自己的预后，往往对疾病进程没有准备。对于如何以及何时向晚期肝病患者提供预后相关信息、应由谁参与以及应讨论什么，我们知之甚少。我们对肝病临床医生和晚期肝病患者的多职业样本进行了深入访谈。参与者来自三个地理位置不同的机构（新英格兰、得克萨斯州、加利福尼亚州）。我们使用归纳和演绎的定性数据分析方法来确定与晚期肝病预后讨论相关的主题。主题分析侧重于预后讨论的内容、时间和参与者的角色。共有31名晚期肝病患者和26名多职业临床医生完成了访谈。大多数参与者对预后的概念界定很宽泛，不仅仅是对生存的预测，还包括对疾病进程的预期、处理或避免并发症的方法以及处理患者情绪的必要性。患者倾向于在晚期肝病病程早期开始讨论，并欢迎采用多职业的方式进行讨论。临床医生则倾向于让专科医生发挥更大的作用。所有参与者都认识到晚期肝病预后讨论很少进行，并赞成采用结构化、标准化的方法来广泛讨论预后。晚期肝病患者及其临床医生赞成采用多层面的方法进行预后谈话，包括对预期寿命的讨论、对肝病可能病程的预测以及随着时间推移功能和能力的预期变化。结构化和早期的预后讨论应该成为晚期肝病常规护理的一部分。
Advanced Liver Disease (AdvLD) is common, morbid, and associated with high likelihood of death. Patients may not fully understand their prognosis and are often unprepared for the course of illness. Little is known about how and when to deliver prognosis-related information to patients with AdvLD, who should participate, and what should be discussed. We conducted in-depth interviews with a multi-profession sample of Hepatology clinicians and patients with AdvLD. Participants were drawn from three geographically diverse facilities (New England, Texas, California). We used inductive and deductive qualitative data analysis approaches to identify themes related to AdvLD prognosis discussions. Thematic analysis focused on content, timing, and participants’ roles in prognosis discussions. In total, 31 patients with AdvLD and 26 multi-profession clinicians completed interviews. Most participants provided a broad conceptualization of prognosis beyond predictions of survival, including expectations about illness course, ways to manage or avoid complications and a need to address patients’ emotions. Patients favored initiating discussions early in the AdvLD course and welcomed a multi-profession approach to conducting discussions. Clinicians favored a larger role for specialty physicians. All participants recognized that AdvLD prognosis discussions occur infrequently and favored a structured, standardized approach to broadly discussing prognosis. Patients with AdvLD and their clinicians favored a multifaceted approach to prognosis conversations including discussions of life expectancy, predictions about likely course of liver disease, and expected changes in function and capabilities over time. Structured and early prognosis discussions should be part of routine AdvLD care.
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影响因子：
12.6
作者：
Naik, Aanand D.;Arney, Jennifer;Clark, Jack A.;Martin, Lindsey A.;Paragraph, Anne M. Walling;Stevenson, Autumn;Smith, Donna;Asch, Steven M.;Kanwal, Fasiha
通讯作者：
Kanwal, Fasiha
影响因子：
2.9
作者：
Low J;Davis S;Vickerstaff V;Greenslade L;Hopkins K;Langford A;Marshall A;Thorburn D;Jones L
通讯作者：
Jones L
影响因子：
9.7
作者：
Lakin, Joshua R.;Koritsanszky, Luca A.;Bernacki, Rachelle E.
通讯作者：
Bernacki, Rachelle E.
影响因子：
2.7
作者：
Highet, Gill;Crawford, Debbie;Boyd, Kirsty
通讯作者：
Boyd, Kirsty
影响因子：
45.3
作者：
Mack, Jennifer W.;Wolfe, Joanne;Weeks, Jane C.
通讯作者：
Weeks, Jane C.