Shifting the focus of advance care planning: using an in-depth interview to build and strengthen relationships.
Shifting the focus of advance care planning: using an in-depth interview to build and strengthen relationships.
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DOI：
10.1089/109662104773709503
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发表时间：
2004-04-01
影响因子：
2.8
通讯作者：
Briggs, Linda
中科院分区：
文献类型：
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作者：
Briggs, Linda
大约4年前，当我加入威斯康星州拉克罗斯的冈德森路德医学中心的尊重选择®高级护理计划（ACP）团队时，我被分配负责为该计划设计一个全面的课程，该课程可以带到其他社区，以帮助他们复制全国公认的拉克罗斯经验的成功。1同时，Gundersen Lutheran的质量改进团队（一家为整个威斯康星州西部、明尼苏达州东南部和爱荷华州东北部的患者提供医疗保健的三级教学医院）发现了当前计划中的各种差距，并希望改善门诊患者早期启动ACP的结果，满足不同患者人群的需求，以及加强我们专业人员的协助技巧。所出现的是嵌入在我们现有计划中的原则和实践的演变和扩展。本文介绍了开发一个以患者为中心的ACP采访的人患有慢性危及生命的疾病和他们的代理决策者的基本原理，提供了一个案例的仔细探索，从一个试点研究，我们进行了27例患者代理对，并阐明了我们迄今为止从我们的努力，以实现这一强化版本的提前护理计划的经验教训。这种与有严重并发症风险的人进行有意义的对话的深入努力表明了ACP领域的发展。它“提高了标准”，并可视化了如果ACP从文档驱动的、以决策为中心的事件转变为强调关系的、以患者为中心的过程，可以实现什么。这一转变的成果将不是通过增加已完成的预先指示的数量来衡量，而是通过提高对寿命终了体验的满意度来衡量。
WHEN Ijoined THE Respecting Choices® Advance Care Planning (ACP) team at Gundersen Lutheran Medical Center in La Crosse, Wisconsin, almost 4 years ago, I was assigned the responsibility of designing a comprehensive curriculum for this program that could be taken to other communities to assist them in replicating the success of the nationally recognized La Crosse experience. 1 Concurrently, the quality improvement team at Gundersen Lutheran (a tertiary teaching hospital providing health care to patients throughout western Wisconsin, southeastern Minnesota, and northeastern Iowa) identified a variety of gaps in the current program, and wanted to improve outcomes in such areas as early initiation of ACP in the outpatient setting, meeting the needs of different patient populations, and strengthening the facilitation skills of our professionals. What emerged has been an evolution and expansion of the principles and practices embedded in our existing program. This article describes the rationale for developing a patient-centered ACP interview for persons suffering from chronic life-threatening illness and their surrogate decision makers, offer a careful exploration of one case example from a pilot study we conducted with 27 patient-surrogate pairs, and elucidate the lessons we have learned thus far from our efforts to implement this fortified version of advance care planning. This in-depth effort to implement meaningful conversations with people who are at risk of serious complications demonstrates an evolution of the field of ACP. It “raises the bar” and visualizes what can be achieved if ACP is transformed from a document-driven, decision-focused event to one that emphasizes a relational, patient-centered process. The outcomes of such a transformation will not be measured by increasing the number of completed advance directives, but by improving satisfaction with the end-of-life experience.