Exploring patient-reported barriers to advance care planning in family practice
Exploring patient-reported barriers to advance care planning in family practice
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DOI：
10.1186/s12875-020-01167-0
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发表时间：
2020-05-25
影响因子：
2.9
通讯作者：
Howard, Michelle
中科院分区：
文献类型：
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作者：
Bernard, Carrie;Tan, Amy;Howard, Michelle
虽然以病人为中心的护理在所有医学专业中变得越来越重要，但当涉及到临终关怀时，研究表明，所订购的治疗往往与人们表达的偏好不一致。当患者不能为自己说话时，患者和家属参与初级保健环境中的预先护理计划（ACP）可以改善患者愿望与所接受的医疗保健之间的一致性。本研究的目的是为了更好地了解老年患者在与家人和家庭医生谈论ACP时所面临的障碍。方法在这个多地点横断面研究中，三个关于患者难以与家人或家庭医生讨论ACP的原因的自由文本问题是关于患者ACP知识和参与的自我管理问卷的一部分。该问卷包括封闭式问题和三个探索性开放式问题，在加拿大3个省的20个家庭诊所中分发。运用主题分析法对自由文本反应进行分析，为本文的研究奠定基础。当被问及为什么他们没有和别人谈论ACP时，102名参与者提供了可分析的回答。254人回答了与医生交谈的问题，340人回答了与家人交谈的问题。从自由文本响应分析中可以得出八个不同的主题：对于ACP来说，他们太年轻了；2. 这个话题太情绪化了；3. 医学博士（MD）应该负责培养acp4。害怕对医患关系产生负面影响；5. 没有足够的时间预约；6. 关注家庭动态；7. 这不是一个优先事项；和8。对ACP缺乏了解。我们样本中的患者描述了讨论ACP的许多障碍，包括担心这些讨论可能对与家庭成员和家庭医生的关系产生影响，以及与患者对ACP本身的重要性、责任或相关性的认识和解释有关的问题。家庭医生可能处于独特的地位，可以利用他们与患者之间的纵向、以人为本的关系来减轻这些障碍。
Background Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people's expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improve the concordance between patients' wishes and the healthcare received when patients cannot speak for themselves. The aim of this study was to better understand the barriers faced by older patients regarding talking to their family members and family physicians about ACP. Methods In this multi-site cross-sectional study, three free text questions regarding reasons patients found it difficult to discuss ACP with their families or their family physicians were part of a self-administered questionnaire about patients' knowledge of and engagement in ACP. The questionnaire, which included closed ended questions followed by three probing open ended questions, was distributed in 20 family practices across 3 provinces in Canada. The free text responses were analyzed using thematic analysis and form the basis of this paper. Results One hundred two participants provided an analyzable response to the survey when asked why they haven't talked to someone about ACP. Two hundred fifty-four answered the question about talking to their physician and 340 answered the question about talking to family members. Eight distinct themes emerged from the free text response analysis: 1. They were too young for ACP; 2. The topic is too emotional; 3. The Medical Doctor (MD) should be responsible for bringing up ACP 4. A fear of negatively impacting the patient-physician relationship; 5. Not enough time in appointments; 6. Concern about family dynamics; 7. It's not a priority; and 8. A lack of knowledge about ACP. Conclusions Patients in our sample described many barriers to ACP discussions, including concerns about the effect these discussions may have on relationships with both family members and family physicians, and issues relating to patients' knowledge and interpretation of the importance, responsibility for, or relevance of ACP itself. Family physicians may be uniquely placed to leverage the longitudinal, person- centred relationship they have with patients to mitigate some of these barriers.