Advance care planning for patients with cancer in the palliative phase in Dutch general practices
Advance care planning for patients with cancer in the palliative phase in Dutch general practices
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DOI：
10.1093/fampra/cmy124
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发表时间：
2019-10-01
期刊：
影响因子：
2.2
通讯作者：
Schers, Henk J.
中科院分区：
文献类型：
--
作者：
Ermers, Daisy J. M.;van Bussel, Karin J. H.;Schers, Henk J.
背景预先护理计划（ACP）是姑息治疗的关键要素。它提高了临终关怀的质量，减少了侵略性和不必要的延长生命的医疗干预。然而，人们对其在日常实践中的应用知之甚少。本研究旨在探讨ACP在癌症患者中的应用。我们在荷兰的11个全科诊所进行了一项回顾性队列研究。分析了结直肠癌或肺癌死亡患者的电子病历（EPR）。ACP文件的数据，医疗专家和GP之间的通信，并在生命的最后一年的医疗保健使用。分析了163例死亡患者的记录。在74%的记录中，一个或多个ACP项目被注册。全科医生特别记录了患者对安乐死（58%）、姑息性镇静（46%）和首选死亡地点（26%）的偏好。每名患者平均收到6封来自医学专家的信。这些信件主要载有关于医疗的资料，很少载有机场核心计划项目。在生命的最后一年，患者联系GP超过30次，51%的患者至少去过急诊科一次，其中54%在最后一个月。在全科医生的环保工作报告中登记的ACP项目似乎有限。ACP元素很少在初级和二级护理之间进行交流，这可能会影响患者生命最后一年护理的连续性。需要更加重视ACP项目的登记，并更好地交流有关患者偏好的信息。
Background. Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice.Methods. We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed. Data on ACP documentation, correspondence between medical specialist and GP, and health care use in the last year of life were extracted.Results. Records of 163 deceased patients were analysed. In 74% of the records, one or more ACP items were registered. GPs especially documented patients' preferences for euthanasia (58%), palliative sedation (46%) and preferred place of death (26%). Per patient, GPs received on average six letters from medical specialists. These letters mainly contained information regarding medical treatment and rarely ACP items. In the last year of life, patients contacted the GP over 30 times, and 51% visited the emergency department at least once, of whom 54% in the last month.Conclusions. Registration of ACP items in GPs' EPRs appeared to be limited. ACP elements were rarely subject of communication between primary and secondary care, which may impact the continuity of patient care during the last year of life. More emphasis on registration of ACP items and better exchange of information regarding patients' preferences are needed.