Effect of a disease-specific advance care planning intervention on end-of-life care.
Effect of a disease-specific advance care planning intervention on end-of-life care.
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特定疾病的预科护理计划干预对临终护理的影响。
DOI：
10.1111/j.1532-5415.2012.03917.x
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发表时间：
2012-05
影响因子：
6.3
通讯作者：
Brown RL
中科院分区：
文献类型：
--
作者：
Kirchhoff KT;Hammes BJ;Kehl KA;Briggs LA;Brown RL
预先护理计划（ACP）允许患者陈述他们的临终关怀偏好，但这些偏好经常被忽视。在以患者为中心的ACP访谈（PC-ACP）之后，将患者的偏好与临终时接受的护理进行比较。一项随机对照试验对充血性心力衰竭或终末期肾病患者及其替代者进行了研究，这些患者被随机分配接受PC-ACP或常规治疗。威斯康辛州的两个中心有相关的诊所/透析单位提供患者。在完成入组数据的313名患者及其代理人中，110人死亡。在PC-ACP期间，经过培训的调解员评估患者和代理人对疾病的理解和经历，提供有关特定疾病的治疗方案及其益处和负担的信息，协助记录患者的治疗偏好，并协助代理人了解患者的偏好及其作用。他们的偏好被记录下来，然后与通过代理访谈或医疗图表确定的临终关怀进行比较。患者（74%）经常继续自己决定护理直到最后。实验组患者无法实现心肺复苏术愿望的病例比对照组（6/48）少（1/62），但并不明显。实验患者退出透析的人数明显多于对照组。患者和他们的代理人通常愿意与训练有素的引导者讨论偏好。大多数患者在生命结束时得到了他们想要的护理，或者改变了他们的偏好，以符合他们可以得到的护理。需要更大的替代决策者样本来检测显著性。
Advance Care Planning (ACP) allows patients to state preferences for their end of life care but these preferences are frequently ignored. Following a Patient-Centered ACP interview (PC-ACP), patients’ preferences were compared to care received at end of life. A randomized controlled trial was conducted with patients with Congestive Heart Failure or End-stage Renal Disease and their surrogates who were randomized to receive either PC-ACP or usual care. Two centers in Wisconsin with associated clinics/dialysis units provided patients. Of the 313 patients and their surrogates who completed entry data, 110 died. During PC-ACP the trained facilitator assessed the patient and surrogate understanding of and experiences with the illness, provided information about disease-specific treatment options and their benefits and burden, assisted in documentation of patient treatment preferences, and assisted the surrogates in understanding the patient’s preferences and their role. Preferences were documented and then compared to the care received at end of life determined by surrogate interviews or medical charts. Patients (74%) frequently continued to make their own decisions about care to the end. The experimental group had fewer (1/62) but not significantly so cases where the patients could not get their wishes met about CPR than control (6/48). Significantly more experimental patients withdrew from dialysis than control. Patients and their surrogates were generally willing to discuss preferences with a trained facilitator. Most patients received the care they desired at end of life or altered their preferences to be in accord with the care they could receive. A larger sample with surrogate decision makers is needed to detect significance.
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影响因子：
--
作者：
Fried, TR;Byers, AL;Dubin, JA
通讯作者：
Dubin, JA
DOI：
10.1111/j.1532-5415.2000.tb03135.x
发表时间：
2000-05-01
影响因子：
6.3
作者：
Lynn, J;Arkes, HR;Tsevat, J
通讯作者：
Tsevat, J
影响因子：
2.8
作者：
Briggs, Linda
通讯作者：
Briggs, Linda
影响因子：
6.3
作者：
Kirchhoff KT;Hammes BJ;Kehl KA;Briggs LA;Brown RL
通讯作者：
Brown RL
影响因子：
5.7
作者：
Fried, Terri R.;O'Leary, John R.
通讯作者：
O'Leary, John R.