A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery
A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery
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DOI：
10.1097/01.mlr.0000178192.10283.b4
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发表时间：
2005-10-01
期刊：
影响因子：
3
通讯作者：
Hammes, B
中科院分区：
文献类型：
--
作者：
Song, MK;Kirchhoff, KT;Hammes, B
背景：尽管许多医疗保健提供者和研究人员认为有必要帮助终末期慢性疾病患者制定临终计划，但他们倾向于避免在大手术前与患者讨论临终问题。因此，手术患者及其家属通常没有足够的知识来制定计划，以防危及生命的并发症。目的：本研究的目的是评估以患者为中心的提前护理计划（PC-ACP）的短期效果。设计和受试者：32对接受心脏手术的患者及其替代者被随机分配接受PC-ACP干预（PC-ACP）或常规护理。测量：研究的测量是关于未来医疗保健目标的患者-代理一致性，患者和代理对预先护理计划和焦虑的知识，以及患者决策冲突。在干预前后分别测量一致性和焦虑。干预后测量决策冲突和预先护理计划知识。结果：与对照组相比，PC-ACP显著提高了患者与代理的一致性（Delta值为1,27,P < 0.01），显著减少了患者的决策冲突（Delta值为-0.77,P < 0.05）。焦虑变化（前后）在治疗组和对照组之间没有差异。两组患者在预先护理计划知识方面无差异。结论：PC-ACP是一种有效的提前护理计划方法。它的特异性和与患者实际医疗状况的相关性（如心脏手术相关潜在并发症的计划）可以导致更大的患者-代理一致性，而不会增加决策冲突和焦虑。
Background: Although many healthcare providers and researchers consider it necessary to assist patients with end-stage chronic illnesses to plan for the end of life, they tend to avoid discussing end-of-life issues with patients before major surgery. Consequently, surgical patients and their families generally have insufficient knowledge to make plans in case of life-threatening complications.Objective: The objective of this study was to evaluate short-term effects of Patient-Centered Advance Care Planning (PC-ACP).Design and Subjects: Thirty-two dyads of patients undergoing cardiac surgery and their surrogates were randomly assigned to receive either the PC-ACP intervention (PC-ACP) or usual care.Measures: Measures studied were patient-surrogate congruence regarding goals for future medical care, patient and surrogate knowledge of advance care planning and anxiety, and patient decisional conflict. Congruence and anxiety were measured before and after the intervention. Decisional conflict and knowledge of advance care planning were measured after the intervention.Results: Compared with the control group, PC-ACP significantly improved patient-surrogate congruence (Delta 1,27, P < 0.01) and reduced patients' decisional conflict (Delta -0.77, P < 0.05). Anxiety change (pre/post) did not differ between treatment and control groups. No difference in knowledge of advance care planning was found between the 2 groups.Conclusions: The PC-ACP can be an effective approach to advance care planning. Its specificity and relevance to patients' actual medical conditions (as exemplified by its plans for potential complications related to cardiac surgery) can lead to greater patient-surrogate congruence without increasing decisional conflict and anxiety.