Barriers to advance care planning in chronic obstructive pulmonary disease
Barriers to advance care planning in chronic obstructive pulmonary disease
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DOI：
10.1177/0269216309106790
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发表时间：
2009-10-01
影响因子：
4.4
通讯作者：
Ruse, C.
中科院分区：
文献类型：
--
作者：
Gott, M.;Gardiner, C.;Ruse, C.
英语临终关怀战略承诺，所有患有晚期、限制生命的疾病的患者都将有机会参与高级护理计划(ACP)。对于慢性阻塞性肺疾病(COPD)患者，在实践中实现这一目标的障碍尚未得到充分探索。共举行了五个焦点小组，共有39名卫生保健专业人员参与护理慢性阻塞性肺疾病患者。与会者报告说，与慢性阻塞性肺病有关的讨论很少与慢性阻塞性肺病患者展开，并确定了以下障碍：没有提供关于慢性阻塞性肺病确诊时可能的病程的信息；缺乏关于谁应该启动非加性肺病以及在什么情况下启动非加氧性肺病的共识；将慢性阻塞性肺病与癌症进行比较的内涵；非加氧性肺病的讨论与慢性病管理的目标相冲突；以及对慢性阻塞性肺病背景下“生命终结”的含义缺乏理解。这项研究的结果表明，对于慢性阻塞性肺疾病患者，在实现生命末期护理战略关于患者参与生命末期决策的目标之前，需要显著改善服务。虽然调查结果支持该战略的建议，即迫切需要专业教育和增加有关临终问题的公众教育，但调查结果也表明，仅有这些并不足以实现所需的改变程度。还需要考虑将慢性病管理和临终关怀结合起来，并制定符合“持续缓解”概念的临终关怀定义。
The English End of Life Care Strategy promises that all patients with advanced, life limiting illness will have the opportunity to participate in Advance Care Planning (ACP). For patients with Chronic Obstructive Pulmonary Disease (COPD), the barriers to this being achieved in practice are under-explored. Five focus groups were held with a total of 39 health care professionals involved in the care of patients with COPD. Participants reported that discussions relating to ACP are very rarely initiated with patients with COPD and identified the following barriers: inadequate information provision about the likely course of COPD at diagnosis; lack of consensus regarding who should initiate ACP and in which setting; connotations of comparing COPD with cancer; ACP discussions conflicting with goals of chronic disease management; and a lack of understanding of the meaning of 'end of life' within the context of COPD. The findings from this study indicate that, for patients with COPD, significant service improvement is needed before the objective of the End of Life Care Strategy regarding patient participation in end of life decision-making is to be achieved. Whilst the findings support the Strategy's recommendations regarding an urgent for both professional education and increased public education about end of life issues, they also indicate that these alone will not be enough to effect the level of change required. Consideration also needs to be given to the integration of chronic disease management and end of life care and to developing definitions of end of life care that fit with concepts of 'continuous palliation'.