老年痴呆症患者预立医疗照护计划的研究进展

目的 了解国内外预立医疗照护计划在老年痴呆症群体中的研究进展,为预立医疗照护计划在我国的有效实施提供理论参考。方法 检索国内外相关数据库,对预立医疗照护计划的概述、实施现状、实施效果评价进行综述。结果 预立医疗照护计划是老年痴呆症患者高质量护理中的一部分,但目前支持老年痴呆症患者直接参与决策的研究较少,针对于老年痴呆症患者预立医疗照护计划的主要实施内容包括：及时评估患者决策能力;支持家庭成员有效参与;创新人员培训途径;充实预立医疗照护计划的对话内容;丰富预立医疗照护计划的对话场所与对话方式。实施效果评价工具包括：预先医疗指示、临终护理偏好问卷、决策冲突量表、医疗服务使用情况、预立医疗照护计划态度。结论 预立医疗照护计划可有效保障老年痴呆症患者的医疗决策自主权,但未来需要进一步完善老年痴呆症患者与家庭成员共同参与决策的研究去实现预立医疗照护计划在老年痴呆症患者中的临床应用。     

COPD患者预立医疗照护计划的研究进展

目的 综述预立医疗照护计划在COPD患者的研究进展,为我国COPD患者预立医疗照护计划的开展提供参考。方法 主要从预立医疗照护计划的内涵、相关概念、COPD患者实施预立医疗照护计划的现状、影响因素和策略进行阐述。结果 预立医疗照护计划作为COPD患者护理中的重要一部分,但在临床执行力不高。影响因素有：疾病性质、医生方面、患者方面与沟通方面。干预策略主要包括增加以护士为主导的干预、进行多学科的合作与培训、加强医护人员与患者的沟通。结论 COPD患者可以从预立医疗照护计划中受益,应该采取相应措施将其应用到我国COPD患者身上。     

脑卒中患者预立医疗照护计划研究进展

文章综述了预立医疗照护计划的相关概念、脑卒中患者预立医疗照护计划的实施现状及主要测评工具,从疾病认知、预立医疗照护计划知识储备、沟通有效性等方面分析了影响我国脑卒中患者预立医疗照护计划实施的因素,提出开发专业测评工具、增进患者对于自身疾病的了解、开展医患双方预立医疗照护计划知识教育、促进医护患间有效沟通及组建多学科合作的专业化团队等建议,以期为预立医疗照护计划在我国脑卒中患者群体中的应用提供理论参考。     

预立医疗照护计划准备度研究进展

对预立医疗照护计划准备度的评估工具、准备度、影响因素进行综述,指出应探索个性化预立医疗照护计划准备度干预模式,制定符合我国国情的不同人群的准备度评估工具,构建符合本土文化背景的预立医疗照护计划推广模式,推广符合我国文化特色的预立医疗照护计划家庭决策模式,从家庭角度出发提高病人预立医疗照护计划准备度。     

终末期患者预立医疗照护计划中沟通模式的研究进展

本文对预立医疗照护计划中沟通的内容、常见的沟通模式进行综述,以期为预立医疗照护计划在我国大陆的开展提供参考.     

预立医疗照护计划准备度的研究进展

综述预立医疗照护计划(ACP)准备度的概念及作用、一般人群及患病人群ACP准备度的评估工具、国内外ACP准备现状及影响因素,旨在为我国ACP的推广、科研人员的调查及各人群ACP准备度水平的提高提供参考,以促进各人群尽早讨论ACP。     

预立医疗照护计划的发展现状与前景分析

目的 对预立医疗照护计划国内外发展现状进行综述,提出我国目前实施预立医疗照护计划面临的现实问题,并对前景进行分析,为我国将来预立医疗照护计划的发展提供参考与指导。方法 通过回顾国内外文献,对目前预立医疗照护计划发展现状进行综述。结果 国外部分国家预立医疗照护计划发展较早,从立法到临床应用,都较为成熟。我国除香港台湾地区之外,尚无对预立医疗照护计划法律上的支持;虽然总体来说,我国居民以及医护人员对预立照护计划的认知度偏低,但近些年,由于公益组织的宣传及感染,民众对预立医疗照护的意识也在逐步提升,对此方面有一定的诉求。结论 预立照护计划是社会文明发展到一定程度出现的产物,它的存在反应人类对生命不断认知的过程;因此,在我国今后预立医疗照护计划的发展及应用指日可待。     

预立医疗照护计划在帕金森患者中的研究进展

阐述预立医疗照护计划的基本内容、预立医疗照护计划在帕金森患者中的应用现状以及相关影响因素,并对预立医疗照护计划在帕金森患者中应用提出建议,旨在为今后我国基于帕金森患者开展预立医疗照护计划提供研究思路。     

艾滋病病人实施预立医疗照护计划的研究进展

对艾滋病的流行病学特点、预立医疗照护计划的概念、实施艾滋病病人预立医疗照护计划的影响因素以及促进终末期艾滋病病人预立医疗照护计划的策略进行综述,以期为临床开展相关工作提供参考.     

决策辅助在预立医疗照护计划中的应用进展

本文综述了决策辅助的起源和重要意义、实施条件、内容、质量评价体系以及在预立医疗照护计划中的应用范围、方式、效果。通过总结近年来决策辅助在预立医疗照护计划中的应用,分析决策辅助对预立医疗照护计划的价值,以期为国内预立医疗照护计划干预方案的制定提供新思路,从而推动我国预立医疗照护计划的发展。     

Personal advance care planning uptake amongst Australian and New Zealand palliative care medical and nursing professionals

Background: Palliative care (PC) medical and nursing professionals are potentially the most death literate group in the community yet little is known about their personal uptake of advance care planning (ACP) or written advance care directives (ACDs).

Aim: To describe Australian and New Zealand PC medical and nursing professionals’ participation in personal ACP activities.

Method: Between 12 May 2014 and 6 June 2014 an anonymous cross sectional online survey about personal ACP activities was distributed to Australian and New Zealand PC medical and nursing professionals.

Results: The survey link was emailed to 946 medical and nursing PC health professionals with 329 (35%) recipients commencing the survey. Ninety-one percent of participating Australian and New Zealand PC medical and nursing health professionals have engaged in some form of ACP; 21% have a written ACD. Over 80% of those without a current ACD have engaged in an ACP conversation with family or significant others. Thirty percent of doctors did not feel an ACD was relevant for them, 29% considered them a low priority, 27% relied on conversations and 14% felt ACDs were poorly designed or ineffective. These proportions were 15%, 44%, 36%, and 2%, respectively for nurses.

Conclusion: This study supports the notion that familiarity with ACP increases overall participation however, it does not support the popular view that familiarity with ACDs ensures uptake. The favoured mode of ACP amongst this group of health professionals was a conversation outlining values and preferences with family or significant others.     

Using the stages of change model to improve communication about advance care planning

TOPIC: Advance care planning (ACP) is a term intended to describe the dynamic process of discussing wishes for future medical care. PURPOSE: To demonstrate how a behavior change model can be used to enhance ACP. SOURCES: Authors' personal experience, workshops, literature review. CONCLUSIONS: Incorporating behavioral change theory helps develop workable interventions and provides strategies for nurses to approach patients appropriately about planning for future medical care.     

医学生预立医疗照护计划知信行调查研究

目的调查医学生对预立医疗照护计划(ACP)的认知、态度、行为意向现状并进行相关影响因素分析。方法本研究为横断面研究。于2019年4—5月,采用便利抽样法选取在广东省3所医学院校及其附属医院实习的医学生作为研究对象。使用一般资料调查问卷、自行设计的医学生ACP知信行问卷对其进行调查。采用多重线性回归分析进行影响因素分析。本次调查共发放问卷276份,回收有效问卷274份,有效回收率为99.3%。结果医学生ACP认知调查问卷的平均正确率为48.75%;ACP态度调查问卷的条目均分为(4.00±0.53)分;医学生ACP行为意向调查问卷的条目均分为(3.94±0.59)分。多重线性回归分析结果显示,对所学专业的态度、有无社会兼职经历、是否听说过ACP以及是否接受过ACP的培训或课程是医学生ACP认知的影响因素(P<0.05);是否进入临床实习和是否有过患者死亡的救治经历是医学生ACP态度的影响因素(P<0.05);对所学专业态度、是否有过患者死亡的救治经历是医学生ACP行为意向的影响因素(P<0.05)。结论医学生对ACP有一定的接受度,但对ACP的知晓率普遍较低。应考虑完善相关教育方法和内容,为医学生在未来临床工作中做好角色适应,提升医学生的人文关怀素养以及ACP在临床中的推广做准备。     

预前照护计划干预效果的Meta分析

目的：系统综述和评价预前照护计划干预的应用效果。方法：计算机检索Cochrane图书馆、Pubmed、EMbase、中国生物医学文献数据库（CBM）、中国知网(CNKI)和万方数据库中关于预前照护计划的随机对照试验,按纳入及排除标准筛选文献并进行质量评价,采用RevMan 5.3软件处理,对纳入文献进行Meta分析。结果：共纳入14篇随机对照试验,受试者4 610例。Meta分析结果显示,干预组签署预先指示者多于对照组[OR=3.50,95%CI（1.89,6.51）,P<0.01];干预组代理人预测患者治疗意愿的准确性高于对照组[OR=3.58,95%CI（1.72,7.45）,P=0.0007];在决策冲突方面,干预组与对照组差异无统计学意义[WMD= -0.02,95%CI（-0.15,0.11）,P=0.75];同时干预有助于提高患者对预先指示的接受度,不会给患者带来任何心理精神方面的压力,但干预是否可以改善患者预先指示认知状况的证据尚不充分。结论：预前照护计划干预可以提高患者生命意愿表达率和代理人预测的准确性、有助于患者接受预先指示,不引发任何心理精神压力问题,但对患者决策冲突和认知水平的影响效果还不确定,仍有待临床开展多中心、大样本随机对照试验来证实。     

预立医疗照护计划利益相关者评估工具的研究进展

该文基于预立医疗照护计划利益相关者概念范围对预立医疗照护计划利益相关者评估工具进行综述,从预立医疗照护计划接受者及提供者角度介绍预立医疗照护计划利益相关者评估工具的特点及应用现状,以期为我国预立医疗照护计划相关研究的开展提供参考。     

预立医疗照护计划准备度评估工具的研究进展

该文对国内外预立医疗照护计划准备度评估工具进行综述,从一般人群、患病人群和其他3个方面对预立医疗照护计划准备度评估工具的主要内容、评分标准、信效度等方面进行阐述,分析、比较现有评估工具存在的问题并提出建议,为预立医疗照护计划准备度评估工具的本土化发展、临床护士选择合适的评估工具以及制订针对性干预措施提供参考。     

Perspectives of healthy elders on advance care planning

Purpose: To present a qualitative study that explored the perspectives of healthy elders on advance care planning.
Data source: Data were gathered through four focus groups and a demographic questionnaire. The focus group data were analyzed using content analysis. A convenience sample of 20 healthy men and women, aged 60–94 years old, was drawn from one community senior center and two assisted living facilities.
Conclusions: The data reveal five major themes: advance care planning is strongly influenced by concern for others; elders assume that preferences are known to their trusted friends, family, and providers, even in the absence of explicit communication with these people; elders value a healthcare system that supports provider time, focus, and continuity; being "known" to a provider is critical to comfort that advance care planning preferences will be respected; and elders are generally ready and eager to discuss advance care planning. Additional findings include: elders are better prepared for the event of death than the dying process; lawyers and financial planners play a prominent role in guiding elders through end-of-life decisions; and elders believe that the optimal time for advance care planning discussion is during periods of relative wellness.
Implications for practice: Enhanced understanding of the patient perspective is key to incorporating advance care planning for healthy elders in the ideal milieu of primary care.     

Preconditions for successful advance care planning in nursing homes: A systematic review

ObjectivesThere is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs.DesignA systematic review.Data sourcesPubMed, PsycINFO, EMBASE and CINAHL.Review methodsTwo authors independently screened publications. One author assessed methodological quality and extracted textual data, which was double-checked for a random sample. We extracted textual data and used thematic synthesis to identify “preconditions”, defined as requirements, conditions and elements necessary to achieve the desired outcome of advance care planning, i.e. attaining concordance between residents' preferences and actual care or treatment received at the end of life.Main findingsBased on 38 publications, we identified 17 preconditions at five different levels: resident, family, health-care professional, facility and community. Most preconditions were situated on multiple levels but the majority addressed professionals and the nursing home itself. We summarized preconditions in five domains: to have sufficient knowledge and skills, to be willing and able to participate in advance care planning, to have good relationships, to have an administrative system in place, and contextual factors supporting advance care planning within the nursing home.ConclusionThere are multiple preconditions related to successfully implementing advance care planning in the complex nursing home setting that operate at micro, meso and macro level. Future interventions need to address these multiple domains and levels in a whole-system approach in order to be better implementable and more sustainable, while simultaneously target the important role of the health-care professional and the facility itself.