General practitioners perceptions on advance care planning for patients living with dementia
General practitioners perceptions on advance care planning for patients living with dementia
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DOI：
10.1186/s12904-015-0019-x
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发表时间：
2015-04-23
影响因子：
3.1
通讯作者：
van der Steen, Jenny T.
中科院分区：
文献类型：
--
作者：
Brazil, Kevin;Carter, Gillian;van der Steen, Jenny T.
背景：预先护理计划 (ACP) 有助于沟通和了解偏好，但 ACP 在初级护理中的使用率较低。痴呆症病程的不确定性以及无法与痴呆症患者沟通是全科医生发起有关护理目标讨论的重大挑战。方法：使用了一项横断面调查，对北爱尔兰登记的痴呆症患者的全科医生进行了有目的的整群样本。选定诊所的全科医生收到了调查工具，并实施了最多四次邮件联系。结果：133 名全科医生 (40.6%) 参与了调查，占受调查诊所的 60.9%。虽然大多数受访者认为痴呆症是一种绝症（96.2%），但只有 37.6% 的人认为从诊断到严重痴呆症，姑息治疗同样适用。虽然大多数受访者认为早期讨论将有助于晚期痴呆症期间的决策（61%），但受访者对于是否应在诊断时启动 ACP 存在分歧。虽然大多数受访者认为全科医生应该主动引入和鼓励 ACP，但大多数调查参与者承认需要提高知识，让家人参与照顾临终痴呆患者，并且需要 ACP 文件的标准格式。结论：ACP 讨论的最佳时机应根据患者和家庭护理人员面对生命终结的准备程度来确定。 ACP 讨论可以通过针对患者和家庭护理人员的教育策略来加强，这些策略可以在考虑未来护理的选择时与他们的全科医生共同决策。
Background: Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care.Methods: A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented.Results: One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed.Conclusion: Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.