Never Waste a Pandemic: Strategies to Increase Advance Care Planning Now.
Never Waste a Pandemic: Strategies to Increase Advance Care Planning Now.
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DOI：
10.1016/j.mayocpiqo.2021.08.001
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
Havyer RD
中科院分区：
文献类型：
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作者：
Alli A;Thorsteinsdottir B;Carey EC;Havyer RD
2019冠状病毒病（COVID-19）相关的死亡和住院造成了全球健康危机，美国部分地区和世界各地的医疗资源和人员前所未有的短缺。这一流行病引发了关于公平分配卫生保健资源的重要讨论。关于COVID-19的新闻头条是家庭成员宣布住院的亲人在治疗方案被拒绝后死亡。其他文章表明，患者可能不完全理解在重症监护环境中选择护理的后果，结果的不可预测性，以及这可能如何影响未来的能力。1在这场大流行病中生存和死亡的现实和观念之间，COVID-19突出了医护人员和患者之间的上游对话的关键作用，以帮助将医疗保健与个人的目标和价值观相结合-这被称为提前护理计划（ACP）。虽然ACP在医疗保健方面具有既定的优先地位，但通常仅限于老年患者或患有严重疾病的患者。尽管COVID-19对老年人群的打击最大，但这一大流行使ACP对话与年轻患者，甚至与住院和死亡相关的先前健康患者相关。2019冠状病毒病大流行的共同经验是一个机会，可以塑造关于ACP的公共话语，并帮助制定定期使用ACP的系统实践，以了解更多关于个体患者的愿望，价值观和治疗计划。2本文旨在促进在当前和未来的流行病或卫生保健危机中对价值一致的卫生保健的上游讨论。因此，我们强调了三个策略，以增加ACP患者的对话迫切：1）重新定义成功，简单地启动ACP讨论-了解患者的价值观，目标和优先事项本身就是一种成就; 2）通过及时的资源和个人或团体培训，解决患者和医护人员对ACP的情绪; 3）通过无所不在和基于团队的方法使ACP讨论规范化，这样患者就不会感到这些对话的针对性或威胁性。
Coronavirus disease 2019 (COVID-19)–related deaths and hospitalizations have created a global health crisis with unprecedented scarcity of health care resources and staffing in parts of the United States and around the world. The pandemic has led to important discussions about just allocation of health care resources. News headlines about COVID-19 feature family members who announce hospitalized loved ones died after treatment options were denied. Other articles demonstrate that patients may not fully understand the ramifications of elected care in an intensive care setting, unpredictability of outcomes, and how this may impact future abilities. 1 Between the realities and perceptions of living and dying in this pandemic, COVID-19 has spotlighted the critical role of upstream conversations between health care workers and patients to help align medical care with the goals and values of the individual—what is referred to as advance care planning (ACP). Although ACP has an established precedence in health care, commonly it has been limited to elderly patients or those with serious illnesses. Although COVID-19 has hit the geriatric population the hardest, the pandemic has made ACP conversations relevant for younger and even previously healthy patients with associated hospitalizations and deaths. The shared experience of the COVID-19 pandemic is an opportunity to shape public discourse about ACP and help develop system practices that regularly use ACP to learn more about individual patient wishes, values, and treatment plans. 2This article aims to facilitate upstream discussions for value-concordant health care during this and future pandemics or health care crises. Accordingly, we highlight three strategies to increase ACP patient conversations urgently: 1) Redefine success as simply initiating an ACP discussion—learning about patients’ values, goals, and priorities is an achievement by itself; 2) Address patient and health care worker emotions about ACP through timely resources and individual or group trainings; and 3) Normalize ACP discussions through omnipresent and team-based approaches, so that patients may feel less targeted or threatened by these conversations.