Abstract：
BACKGROUND: Older people with frailty are susceptible to sudden and rapid deterioration, so discussing their wishes and preferences for care at the end of life should be a priority. However, frailty is often not considered or recognised, which impedes patient-centred decision-making.
OBJECTIVE: To explore the views and perceptions of senior healthcare professionals regarding the usefulness of the Clinical Frailty Scale (CFS) in identifying frailty; whether a CFS score of severe frailty leads senior healthcare professionals to recognise that the person is likely to be approaching the end of life; and whether a CFS score of severe frailty prompts senior healthcare professionals to have conversations about advance care planning and end of life care with patients.
METHODS: Semi-structured individual interviews were undertaken with seven senior healthcare professionals at one hospital in England. Data were analysed using thematic analysis.
RESULTS: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects.
CONCLUSIONS: People with severe frailty may be disadvantaged in terms of receiving appropriate end of life care. Better education on frailty for all healthcare professionals would facilitate conversations about advance care planning and end of life care with patients diagnosed with severe frailty.
OBJECTIVE: To explore the views and perceptions of senior healthcare professionals regarding the usefulness of the Clinical Frailty Scale (CFS) in identifying frailty; whether a CFS score of severe frailty leads senior healthcare professionals to recognise that the person is likely to be approaching the end of life; and whether a CFS score of severe frailty prompts senior healthcare professionals to have conversations about advance care planning and end of life care with patients.
METHODS: Semi-structured individual interviews were undertaken with seven senior healthcare professionals at one hospital in England. Data were analysed using thematic analysis.
RESULTS: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects.
CONCLUSIONS: People with severe frailty may be disadvantaged in terms of receiving appropriate end of life care. Better education on frailty for all healthcare professionals would facilitate conversations about advance care planning and end of life care with patients diagnosed with severe frailty.
摘要：
背景：患有虚弱的老年人容易突然迅速恶化，因此，讨论他们在生命结束时对护理的愿望和偏好应该是一个优先事项。然而,脆弱往往不被考虑或承认，这阻碍了以患者为中心的决策。
目的：探讨高级医疗保健专业人员关于临床衰弱量表（CFS）在识别衰弱中的有用性的观点和看法；严重衰弱的CFS评分是否使高级医疗保健专业人员认识到该人可能即将临终；以及严重衰弱的CFS评分是否促使高级医疗保健专业人员与患者进行有关提前护理计划和临终护理的对话。
方法：对英国一家医院的7名高级医疗保健专业人员进行了半结构化个人访谈。采用专题分析法对数据进行分析。
结果：脆弱似乎很复杂，多方面的，有时很难识别。严重虚弱的诊断并不一定会促使提前制定护理计划和结束生命护理对话。如果这个人有合并症，这样的谈话更有可能发生，比如癌症。预测似乎很有挑战性，部分原因是脆弱的渐进和不确定的轨迹和缺乏理解，在医疗保健专业人员方面，条件及其影响。
结论：严重虚弱的患者在接受适当的临终护理方面可能处于不利地位。对所有医疗保健专业人员进行更好的身体虚弱教育将有助于与被诊断为严重身体虚弱的患者进行有关提前护理计划和临终关怀的对话。
目的：探讨高级医疗保健专业人员关于临床衰弱量表（CFS）在识别衰弱中的有用性的观点和看法；严重衰弱的CFS评分是否使高级医疗保健专业人员认识到该人可能即将临终；以及严重衰弱的CFS评分是否促使高级医疗保健专业人员与患者进行有关提前护理计划和临终护理的对话。
方法：对英国一家医院的7名高级医疗保健专业人员进行了半结构化个人访谈。采用专题分析法对数据进行分析。
结果：脆弱似乎很复杂，多方面的，有时很难识别。严重虚弱的诊断并不一定会促使提前制定护理计划和结束生命护理对话。如果这个人有合并症，这样的谈话更有可能发生，比如癌症。预测似乎很有挑战性，部分原因是脆弱的渐进和不确定的轨迹和缺乏理解，在医疗保健专业人员方面，条件及其影响。
结论：严重虚弱的患者在接受适当的临终护理方面可能处于不利地位。对所有医疗保健专业人员进行更好的身体虚弱教育将有助于与被诊断为严重身体虚弱的患者进行有关提前护理计划和临终关怀的对话。
