Rapid development of a decision-aid for people with dementia and their families during COVID-19
Rapid development of a decision-aid for people with dementia and their families during COVID-19
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DOI：
10.1192/j.eurpsy.2021.277
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发表时间：
2021-08-13
影响因子：
7.8
通讯作者：
Davies, N.
中科院分区：
文献类型：
--
作者：
West, E.;Kupeli, N.;Moore, K.;Sampson, E.;Aker, N.;Nair, P.;Davies, N.
COVID-19作为一场大流行，对老年人，包括痴呆症患者的影响尤为严重。对卫生和社会保健系统的影响要求对这一人群的保健规划和决策采取快速反应办法，其核心是对不断变化的个人和系统需求的反射性和反应性。有鉴于此，利用定性数据和证据合成相结合的方法，开发了一个帮助痴呆症患者家庭的决策工具。利用评估和证据收集相结合的方法，为痴呆症患者家庭制定一项决策援助。与来自国家临终关怀和支持性护理组织的热线工作人员的半结构化访谈构成了工具设计的基础。与痴呆症患者、现任和前任护理人员以及全科实践和社会护理专家共同设计，形成了下一阶段。与此同时，对与老年人在生命结束时作出决定的现有证据进行了快速审查。采访结果涵盖了许多主题，包括在COVID-19背景下决策中的信任、代理和困惑。对现有证据的迅速审查突出表明需要同时考虑决策的过程和结果因素。在COVID-19背景下，结合不同来源和形式的证据，为痴呆症患者及其家人创建一种新的决策工具，既有效又有价值。决策援助包括护理计划、护理人员支持系统、信息获取和应急考虑。发布后，该工具被英国国家医疗服务体系和其他领先的医疗机构采用。没有显著的关系。
COVID-19 as a pandemic has disproportionately affected older adults, including those with dementia. The effects on health and social care systems has necessitated a rapid-response approach to care planning and decision-making in this population, with reflexivity and responsiveness to changing individual and system needs at its core. In light of this, a decision-making tool to help families of persons with dementia was developed using a combination of qualitative data and evidence synthesis. To develop a decision-aid using a combination of assessment and evidence-gathering methods for families of persons with dementia. Semi-structured interviews with helpline staff from national end-of-life and supportive care organisations formed the basis of the tool design. Co-design with people living with dementia, current and former carers and experts in general practice and social care shaped the next stage. Simultaneously, a rapid review of current evidence on making decisions with older people at the end of life was undertaken. Output from interviews covered many topics, including trust, agency and confusion in making decisions in the context of COVID-19. The rapid review of existing evidence highlighted the need to consider both process and outcome elements of decision-making. Combining different sources and forms of evidence was efficient and valuable in creating a novel decision-making tool for persons with dementia and their families within the context of COVID-19. The decision-aid covered care planning, caregiver support systems, access to information and contingency considerations. Upon publication, the tool was adopted by NHS England and other leading healthcare organisations. No significant relationships.