Honing an advance care planning intervention using qualitative analysis: the Living Well interview.
Honing an advance care planning intervention using qualitative analysis: the Living Well interview.
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DOI：
10.1089/109662103768253704
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发表时间：
2003-08-01
影响因子：
2.8
通讯作者：
Ma, Yunsheng
中科院分区：
文献类型：
--
作者：
Schwartz, Carolyn;Lennes, Inga;Ma, Yunsheng
提前护理计划需要明确和全面的讨论病人的价值观和生活质量的概念化。开发了“活得好”开放式访谈干预，以帮助患者及其医疗保健代理人参与有意义的价值观讨论，以便在生命的最后一年做出的决定考虑到患者的价值观。我们使用定性和定量分析来简化这10个问题的访谈，并为未来的研究提出假设。52例绝症患者的访谈编码根据方法的弱点和内容（支持，精神/感情，姑息治疗，生活质量）。节点分析显示，三个主要的和三个备份/探测问题产生的信息，尽量减少错误信息，从所有四个内容领域采样，导致讨论的重要性，良好的规划和决策，并可能导致更早的临终关怀入院比全国平均水平。两个新兴的主题，生成性（将价值或资产传递给下一代）和本质（日常生活中的简单乐趣），然后进行定量分析。与那些没有提到生殖主题的人相比，提到生殖主题的人往往年龄较大，在临终关怀中心停留的时间较长，并且在采访后死亡的时间较长。提到本质的人也往往年龄较大，但往往有一个较短的临终关怀停留时间和较短的时间死亡后的采访。我们的结论是，这次采访可能会提高获得临终关怀，而生成性和本质是值得未来研究的主题。
Advance care planning requires an explicit and comprehensive discussion of patient values and conceptualization of quality of life. The Living Well open-ended interview intervention was developed to help patients and their health care agents to engage in a meaningful discussion of values so that decisions made in the last year of life are made with the patients' values in mind. We used qualitative and quantitative analysis to streamline this 10-question interview, and to generate hypotheses for future research. Interviews with 52 terminally ill patients were coded according to methodological weaknesses and content (support, spirit/feelings, palliative care, and quality of life). Node analysis revealed that three primary and three backup/probe questions yielded information that minimized misinformation, sampled from all four content areas, led to discussions of importance for good planning and decision-making, and may have led to earlier hospice admission than the national average. Two emerging themes, Generativity (passing on values or assets to the next generation) and essence (simple pleasures in everyday life), and were then quantitatively analyzed. People who mentioned generativity tended to be older, had a longer length of hospice stay, and a longer time to death after interview, compared to those who did not mention the theme. People who mentioned essence also tended to be older, but tended to have a shorter length of hospice stay and a shorter time to death after the interview. We conclude that this interview may improve access to hospice, and that generativity and essence are worthwhile themes for future research.