Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?
Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?
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DOI：
10.2215/cjn.11351015
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发表时间：
2016-05-06
影响因子：
9.8
通讯作者：
Vig, Elizabeth K.
中科院分区：
文献类型：
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作者：
O'Hare, Ann M.;Szarka, Jackie;Vig, Elizabeth K.
背景和目的人们对加强肾脏疾病患者的提前护理计划的兴趣与日俱增。我们的目标是引发对护理晚期肾病患者的多学科提供者提前护理计划的观点。设计、设置、参与者和测量2014年4月至12月，我们在普吉特健康护理系统退伍军人事务部对来自一系列学科和专业的26名护理晚期肾病患者的提供者进行了半结构化访谈。参与者被问及他们对这一人群中提前护理计划的看法和经验。访谈被录音、转录，并使用扎根理论进行归纳分析。结果本研究的受访提供者的评论表明，支持晚期肾脏疾病患者提前护理计划的过程存在显著的系统层面的障碍。我们确定了四个重叠的主题：(1)这一人群的医疗保健是复杂的，不同环境和提供者之间的，随着时间的推移而分散的；(2)对提前护理计划及其与其他护理方面的关系，如透析决策，缺乏共同的理解和愿景；(3)提前护理计划的责任和权力中心不明确；(4)不同护理人员之间缺乏围绕提前护理计划的积极合作和沟通。结论护理晚期肾病患者的提供者的评论突出了围绕这一人群的提前护理计划进行跨学科协作的必要性和挑战。可能需要各种组织层面的系统性努力，以支持护理晚期肾脏疾病患者的不同提供者之间围绕提前护理计划的团队合作。
Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.Design, setting, participants, & measurements Between April and December of 2014, we conducted semi structured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.Results The comments of providers interviewed for this study spoke to significant system level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients.Conclusions The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.