Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel
Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel
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DOI：
10.1016/j.jpainsymman.2016.12.331
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发表时间：
2017-05-01
影响因子：
4.7
通讯作者：
Heyland, Daren K.
中科院分区：
文献类型：
--
作者：
Sudore, Rebecca L.;Lum, Hillary D.;Heyland, Daren K.
上下文。尽管人们对提前护理计划(ACP)和以前的ACP描述越来越感兴趣，但目前还没有一个共识的定义来指导临床、研究和政策倡议。本研究的目的是为成年人建立一个一致的ACP定义。我们召集了一个由来自四个国家的52名临床医生、研究人员和政策领导人组成的德尔福多学科国际ACP专家小组和一个患者/代理咨询委员会。我们使用改进的德尔菲法进行了10轮调查，并对专家小组成员的意见进行了定性分析。小组成员确定了几个缺乏共识的主题，并反复讨论并制定了最终的共识定义。小组成员指出了与ACP概念有关的几个矛盾，例如定义是否应侧重于对话还是书面的提前指示；患者的价值观与治疗偏好；当前共同决策与未来医疗决策；以及谁应该被纳入这一过程。专家小组最终达成了一句话的定义和相应的目标声明：“高级护理计划是一个支持任何年龄或健康阶段的成年人理解和分享他们的个人价值观、生活目标和对未来医疗保健的偏好的过程。提前护理计划的目标是帮助确保人们在严重和慢性病期间接受与他们的价值观、目标和偏好一致的医疗护理。该小组还描述了在ACP.结论中最好地支持成年人的战略。一个多学科的德尔福小组为成人ACP制定了共识定义，可用于为ACP临床、研究和政策倡议的实施和衡量提供信息。由爱思唯尔公司代表美国临终关怀与姑息医学学会出版。
Context. Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives.Objective. The aim of this study was to develop a consensus definition of ACP for adults.Methods. We convened a Delphi panel of multidisciplinary, international ACP experts consisting of 52 clinicians, researchers, and policy leaders from four countries and a patient/surrogate advisory committee. We conducted 10 rounds using a modified Delphi method and qualitatively analyzed panelists' input. Panelists identified several themes lacking consensus and iteratively discussed and developed a final consensus definition.Results. Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients' values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: "Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.'' The panel also described strategies to best support adults in ACP.Conclusions. A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.