Traetment Goals at the End of Life

虽然满足患者的偏好是高质量慢性病和临终关怀的核心组成部分， 患者的偏好常常得不到满足。满足偏好的必要第一步是改进 提前护理计划，患者表达其对未来护理偏好的过程， 他们不能再参与决策。这项竞争性研究的结果 更新是基于建议，传统的概念化的提前护理计划（ACP）作为 文件填写不充分。相反，非加太国家方案最好被概念化为一个进程， 患者与护理人员和医生之间关于患者治疗目标的沟通。此外，本发明还 ACP可能最好被概念化为一种健康行为。 该项目的目的是应用健康行为改变模型来推进护理计划， 确定改善非加太国家方案的潜在干预措施的组成部分、层面和范围。项目 建议采用定性和定量相结合的方法。在定性部分，重点小组和 将利用个别访谈来了解居住在社区的老年人的看法， 晚期癌症、充血性心力衰竭和慢性阻塞性肺病及其护理人员 关于健康信念和跨理论模型的结构，因为它们与ACP有关。标准 定性分析技术将被用于理解易感性的概念， 障碍、利益、自我效能、变革阶段和变革过程，因为它们与 不同民族和种族背景的患者和护理人员的经验。在定量部分 在这项研究中，将制定量表，以便于衡量这些概念。的发展 定量措施是今后研究经济、社会和文化之间关系的必要先决条件。 结构之间的结构和ACP，这将提供进一步的见解设计 有效干预。

Although meeting patients' preferences is a central component of quality chronic and end-of-life care, patients' preferences are frequently not met. A necessary first step to meeting preferences is to improve advance care planning, the process by which patients express their preferences for future care in the case that they can no longer participate in decision-making. The results of study on which this competitive renewal is based suggest that the traditional conceptualization of advance care planning (ACP) as the completion of documents is inadequate. Rather, ACP is better conceptualized as a process of communication between patient and both caregiver and physician about patients' treatment goals. Further, ACP may be best conceptualized as a health behavior. The aim of this project is to apply models of health behavior change to advance care planning in order to determine the components, dimension, and scope of potential interventions to improve ACP. The project proposes the use of mixed qualitative and quantitative methods. In the qualitative portion, focus groups and individual interviews will be utilized to elicit the perceptions of older community-dwelling persons with advanced cancer, congestive heart failure, and chronic obstructive pulmonary disease and their caregivers regarding the constructs of the Health Beliefs and Transtheoretical Models as they relate to ACP. Standard qualitative analytical techniques will be used to ground an understanding of the concepts of susceptibility, barriers, benefits, self-efficacy, stages of change, and processes of change as they relate to ACP in the experiences of patients and caregivers of diverse ethnic and racial backgrounds. In the quantative portion of the study, scales will be developed to facilitate the measurement of these concepts. The development of quantitative measures is a necessary prerequisite for future work to examine relationships among the constructs and between the constructs and ACP, which will provide further insights into the design of effective interventions.