Description of an advance care planning intervention in nursing homes: outcomes of the process evaluation.
Description of an advance care planning intervention in nursing homes: outcomes of the process evaluation.
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对疗养院的预先护理计划干预的描述：过程评估的结果。
DOI：
10.1186/s12877-018-0713-7
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发表时间：
2018-01-25
期刊：
影响因子：
4.1
通讯作者：
Flo E
中科院分区：
文献类型：
--
作者：
Aasmul I;Husebo BS;Flo E
高级护理计划（ACP）是患者、家人和医疗保健专业人员之间的重复沟通和决策过程。本研究描述了一个ACP干预疗养院，并评估实施过程中的结果。ACP干预是一项为期4个月的复杂的随机分组对照试验（COSMOS）的一部分。邀请37家挪威疗养院的72个单位（1个集群= 1个单位）和765名患者参加，并将符合条件的单位随机分配到干预组或对照组。护理之家的工作人员在干预组提供了一个标准化的教育计划，学习早期和反复与病人和家属的沟通，并在他们的单位实施ACP。我们采用了培训培训员的方法来教育各单位的工作人员，并在两个月后定期打电话和举办中途研讨会。使用由不同通信可交付成果组成的个体患者日志来评价实施过程。在定性内容分析的支持下，我们根据中途研讨会和个体患者日志的反馈确定了ACP实施的促进因素和障碍。ACP干预在36个NH单位（n = 297）进行; 105名医疗保健提供者参加了研究前的教育研讨会，每个单位的3-4名员工参加了中途研讨会。国家卫生工作人员报告了与执行战略有关的教育材料。患者日志显示，使用我们预定义的实施标准，在62%（n = 183）的患者中成功实施了ACP。工作人员强调，应向作为重要促进者的领导人和工作人员明确传达ACP的相关性，并沿着明确界定的例行程序、作用和责任。查明的障碍包括缺乏能力、认为缺乏时间以及文化和工作人员意见相互冲突。每月与家庭沟通是最经常进行的沟通，成功实施ACP的预定标准基本上得到了实现。疗养院的日常工作和领导和工作人员的参与是至关重要的促进因素，而缺乏时间和能力减少了实施的成功。COSMOS试验已于2014年7月7日在ClinicalTrials.gov（NCT 02238652）上注册。本文的在线版本（10.1186/s12877-018-0713-7）包含补充材料，可供授权用户使用。
Advance Care Planning (ACP) is the repeated communication and decision-making process between the patient, family, and healthcare professionals. This study describes an ACP intervention in nursing homes and evaluates the outcomes of the implementation process. The ACP intervention was part of a 4-month complex, cluster randomized controlled trial (COSMOS). 37 Norwegian nursing homes with 72 units (1 cluster = 1 unit) and 765 patients were invited to participate and eligible units were randomised to the intervention group or control. Nursing home staff in the intervention group was offered a standardized education programme to learn early and repeated communication with patients and families and to implement ACP in their units. We used a train-the-trainer approach to educate staff in the units, supported by regular telephone calls and a midway seminar after two months. Individual patient logs consisting of different communication deliverables were used to evaluate the implementation process. Supported by Qualitative Content Analyses, we identified facilitators and barriers of the ACP implementation based on feedback during midway seminars and individual patient logs. The ACP intervention was conducted in 36 NH units (n = 297); 105 healthcare providers participated at the education seminar prior to the study, and 3–4 employees from each unit participated in the midway seminar. NH staff reported the educational material relevant for the implementation strategy. The patient logs showed that ACP was successfully implemented in 62% (n = 183) of the patients using our predefined implementation criteria. The staff emphasized the clear communication of the relevance of ACP addressed to leaders and staff as important facilitators, along with the clearly defined routines, roles and responsibilities. Identified barriers included lack of competence, perceived lack of time, and conflicting culture and staff opinions. Monthly communication with the family was the most frequently conducted communication, and the predefined criteria of successfully implemented ACP were largely achieved. Nursing home routines and engagement of leaders and staff were crucial facilitators, whereas lack of time and competence reduced the implementation success. The COSMOS-trial was registered in the ClinicalTrials.gov (NCT02238652) July 7th, 2014 The online version of this article (10.1186/s12877-018-0713-7) contains supplementary material, which is available to authorized users.
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影响因子：
3.9
作者：
Carlson, Elisabeth;Bengtsson, Mariette
通讯作者：
Bengtsson, Mariette
影响因子：
4.2
作者：
Chan, Helen Y. L.;Pang, Samantha M. C.
通讯作者：
Pang, Samantha M. C.
影响因子：
4.8
作者：
FOLSTEIN, MF;FOLSTEIN, SE;MCHUGH, PR
通讯作者：
MCHUGH, PR
影响因子：
6.7
作者：
Caplan, Gideon A.;Meller, Anne;Willett, Wendy
通讯作者：
Willett, Wendy
影响因子：
6.7
作者：
Gordon, Adam Lee;Franklin, Matthew;Gladman, John R. F.
通讯作者：
Gladman, John R. F.