Primary care clinicians' confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey
Primary care clinicians' confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey
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DOI：
10.1093/fampra/cmz050
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发表时间：
2020-04-01
期刊：
影响因子：
2.2
通讯作者：
Heyland, Daren K.
中科院分区：
文献类型：
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作者：
Howard, Michelle;Langevin, Jessica;Heyland, Daren K.
背景：参与提前护理计划(ACP)的人更有可能得到与他们在生命结束时的目标一致的卫生保健。目的：本研究的目的是描述初级保健临床医生对与患者进行ACP对话的看法。方法：我们在2014-2015年间对初级保健中的家庭医生和非内科临床医生进行了调查。我们比较了家庭医生和非医生临床医生参与ACP的意愿、信心、参与度和对其他临床医生参与ACP 6个方面(发起、交流信息、决策指导、敲定计划、帮助与家庭成员和其他卫生专业人员沟通计划)的接受程度，评分从0=完全不/非常不可接受到6=非常/一直/非常可接受。结果：家庭医生和非医生临床医生的应答率分别为72%(n=117)和69%(n=)。意愿的平均评级(标准差[SD])很高(内科医生为4.5[1.4]至5.0[1.2]；非内科医生为3.4[1.8]至4.6[1.6])。参与者很少(内科医生的平均评分为2.4[1.7]至2.7[1.6]，非内科医生的平均评分为1.0[1.5]至1.4[1.7])。在ACP的所有方面，非内科医生对信心的评分在统计学上显著低于内科医生。两组患者对非内科临床医生参与的可接受性都很高(平均可接受等级大于4)。结论：目前初级保健临床医生对ACP的参与度较低。鉴于非内科临床医生参与的意愿和可接受性很高，增加非内科临床医生的能力可以使初级保健中的ACP得以吸收。
Background: People who engage in advance care planning (ACP) are more likely to receive health care that is concordant with their goals at the end of life. Little discussion of ACP occurs in primary care.Objective: The objective of this study was to describe primary care clinicians' perspectives on having ACP conversations with their patients.Methods: We conducted a survey of family physicians and non-physician clinicians in primary care in 2014-2015. We compared family physicians and non-physician clinicians on willingness, confidence, participation and acceptability for other clinicians to engage in six aspects of ACP (initiating, exchanging information, decision coaching, finalizing plans, helping communicate plans with family members and other health professionals) on scales from 0 = not at all/extremely unacceptable to 6 = very/all the time/extremely acceptable.Results: The response rate was 72% (n = 117) among family physicians and 69% (n = 64) among non-physician clinicians. Mean ratings (standard deviation [SD]) of willingness were high (4.5 [1.4] to 5.0 [1.2] for physicians; 3.4 [1.8] to 4.6 [1.6] non-physician clinicians). There was little participation (mean ratings 2.4 [1.7] to 2.7 [1.6] for physicians, 1.0 [1.5] to 1.4 [1.7] for non-physician clinicians). Non-physician clinicians rated confidence statistically significantly lower than physicians for all ACP aspects. Acceptability for non-physician clinician involvement was high in both groups (mean acceptability ratings greater than 4).Conclusion: Current engagement of primary care clinicians in ACP is low. Given the high willingness and acceptability for non-physician clinician involvement, increasing the capacity of non-physician clinicians could enable uptake of ACP in primary care.