PDF(Pubmed)
Abstract：
BACKGROUND: Advance care planning (ACP) is a process which enables patients to communicate wishes, values, fears, and preferences for future medical care. Despite patient interest in ACP, the frequency of discussions remains low. Barriers to ACP may be mitigated by involving non-physician clinic staff, preparing patients ahead of visits, and using tools to structure visits. An ACP care pathway incorporating these principles was implemented in longitudinal generalist outpatient care, including primary care/family medicine and general internal medicine, in two Canadian provinces. This study aims to understand clinician experiences implementing the pathway.
METHODS: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders.
RESULTS: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway.
CONCLUSIONS: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway.
BACKGROUND: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.
RESULTS: gov/ct2/show/NCT03508557 .
METHODS: The pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders.
RESULTS: Clinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway.
CONCLUSIONS: While the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway.
BACKGROUND: The study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic.
RESULTS: gov/ct2/show/NCT03508557 .
摘要：
背景：高级护理计划（ACP）是一个使患者能够传达愿望的过程，值,恐惧,以及对未来医疗的偏好。尽管患者对ACP感兴趣，讨论的频率仍然很低。非加太障碍可以通过让非医师诊所工作人员参与来减轻，患者在就诊前做好准备，并使用工具来构建访问结构。在纵向通识门诊护理中实施了包含这些原则的ACP护理路径，包括初级保健/家庭医学和普通内科，在加拿大的两个省。本研究旨在了解临床医生实施该途径的经验。
方法：该途径在艾伯塔省的一个家庭实践中实施，不列颠哥伦比亚省（BC）的两个家庭做法，和一家BC内科门诊。医师和专职卫生专业人员根据《严重疾病对话指南》进行了结构化的路径访问。研究结束时，十二名医生和一名社会工作者参加了访谈或焦点小组。定性数据使用迭代方法进行归纳编码，编码器之间的定期会议。
结果：临床医生描述了ACP护理途径的经验，在临床医生层面的影响，以及对患者水平的影响。在每个域中，临床医生描述了实施过程中遇到的障碍和促进者。临床医生还坦率地反映了未来实施的潜力和途径的可持续性。
结论：虽然各省之间的路径实施略有不同，核心经验是路径的实施，并与当前实践相结合，是可行的。跨设置，关于途径结构及其工具的有用性，类似的主题再次出现，对临床医生信心和与患者互动的影响，团队合作和任务授权，与现有工作流的兼容性，和病人的准备和准备。临床医生支持ACP和该途径。
背景：该研究在clinicaltrials.gov（NCT03508557）进行了前瞻性登记。2018年4月25日注册。https://经典。
结果：gov/ct2/show/NCT03508557。
方法：该途径在艾伯塔省的一个家庭实践中实施，不列颠哥伦比亚省（BC）的两个家庭做法，和一家BC内科门诊。医师和专职卫生专业人员根据《严重疾病对话指南》进行了结构化的路径访问。研究结束时，十二名医生和一名社会工作者参加了访谈或焦点小组。定性数据使用迭代方法进行归纳编码，编码器之间的定期会议。
结果：临床医生描述了ACP护理途径的经验，在临床医生层面的影响，以及对患者水平的影响。在每个域中，临床医生描述了实施过程中遇到的障碍和促进者。临床医生还坦率地反映了未来实施的潜力和途径的可持续性。
结论：虽然各省之间的路径实施略有不同，核心经验是路径的实施，并与当前实践相结合，是可行的。跨设置，关于途径结构及其工具的有用性，类似的主题再次出现，对临床医生信心和与患者互动的影响，团队合作和任务授权，与现有工作流的兼容性，和病人的准备和准备。临床医生支持ACP和该途径。
背景：该研究在clinicaltrials.gov（NCT03508557）进行了前瞻性登记。2018年4月25日注册。https://经典。
结果：gov/ct2/show/NCT03508557。
