Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study
Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study
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DOI：
10.1186/s12904-020-00543-y
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发表时间：
2020-03-17
影响因子：
3.1
通讯作者：
Kizawa, Yoshiyuki
中科院分区：
文献类型：
--
作者：
Hamano, Jun;Oishi, Ai;Kizawa, Yoshiyuki
背景为了提高基层医疗的提前护理计划（ACP）的质量，了解患者与家庭医生（FPs）之间提前护理计划讨论的频率和涉及的话题是很重要的。方法对先前的一项多中心横断面观察性研究进行二次分析。本分析的主要结果是门诊患者和FPs之间ACP讨论的频率和涉及的主题。2017年3月，17家诊所的22名家庭医生安排了一天的时间来评估门诊患者，并招募了65岁以上的患者，这些患者被FPs认可为定期就诊。我们定义了三个ACP讨论主题：1)未来日常生活活动下降（ADL）， 2)未来无法进食，3)替代决策者。FPs评估他们是否曾经与每位患者及其家属讨论过ACP主题，以及他们是否在患者参加本研究之前在医疗记录中记录了这些讨论的结果。在日本版的支持和姑息治疗指标工具中，如果患者有至少2项阳性的一般指标或至少1项阳性的疾病特异性指标，我们将患者定义为有恶化和死亡的风险。结果共纳入382例患者，平均年龄77.4±7.9岁，其中63.1%为女性。79名患者（20.7%）与他们的FPs讨论了至少一个ACP话题。然而，只有23名患者（6.0%）与家庭成员和他们的FPs讨论了ACP话题，结果记录在他们的医疗记录中。未来ADL下降的话题比其他两个话题更常被讨论和记录。有恶化和死亡风险的患者比无恶化和死亡风险的患者更常讨论ACP话题（39.4%比16.8%,p < 0.001）。结论：FPs可能会与一些患者讨论ACP，但通常不会在病历中记录讨论的结果。需要鼓励FPs与患者和家属讨论ACP，并在医疗记录中描述所作出的决定。
Background To improve the quality of advance care planning (ACP) in primary care, it is important to understand the frequency of and topics involved in the ACP discussion between patients and their family physicians (FPs). Methods A secondary analysis of a previous multicenter cross-sectional observational study was performed. The primary outcome of this analysis was the frequency of and topics involved in the ACP discussion between outpatients and FPs. In March 2017, 22 family physicians at 17 clinics scheduled a day to assess outpatients and enrolled patients older than 65 years who were recognized by FPs as having regular visits. We defined three ACP discussion topics: 1) future decline in activities of daily living (ADL), 2) future inability to eat, and 3) surrogate decision makers. FPs assessed whether they had ever discussed any ACP topics with each patient and their family members, and if they had documented the results of these discussions in medical records before patients were enrolled in the present study. We defined patients as being at risk of deteriorating and dying if they had at least 2 positive general indicators or at least 1 positive disease-specific indicator in the Japanese version of the Supportive and Palliative Care Indicators Tool. Results In total, 382 patients with a mean age of 77.4 +/- 7.9 years were enrolled, and 63.1% were female. Seventy-nine patients (20.7%) had discussed at least one ACP topic with their FPs. However, only 23 patients (6.0%) had discussed an ACP topic with family members and their FPs, with the results being documented in their medical records. The topic of future ADL decline was discussed and documented more often than the other two topics. Patients at risk of deteriorating and dying discussed ACP topics significantly more often than those not at risk of deteriorating and dying (39.4% vs. 16.8%, p < 0.001). Conclusion FPs may discuss ACP with some of their patients, but may not often document the results of this discussion in medical records. FPs need to be encouraged to discuss ACP with patients and family members and describe the decisions reached in medical records.