PDF(Pubmed)
Abstract：
Advance care planning (ACP) is a process of discussion, reflection and communication, enabling planning for future medical treatment. Despite evidence of benefits of ACP to patients, families and the healthcare system, many die without an opportunity for such conversations, particularly those living with progressive non-malignant conditions. The Royal College of General Practitioners and Marie Curie Daffodil Standards launched in 2020 provide primary care with a structure for improving end-of-life care, including delivery of ACP. Proactive identification of patients is integral to the approach.We report on a quality improvement project which aimed to assess the take-up rate and acceptability in general practice of a timely and personalised ACP conversation using a \'What matters to you\' (WMTY) framework, and to ensure that different diagnostic and demographic groups were included.Patients without previous ACP and potentially in the last year of life were offered an ACP conversation; a survey sought feedback.81% accepted the offer and in most cases, future care guidance was documented using the recognised format in Gloucestershire for recording ACP conversations, the Recommended Summary for Emergency Care and Treatment (ReSPECT) plan. Clinician and patient satisfaction was high.We concluded that an ACP discussion using a \'WMTY\' format was highly acceptable to most. With recognised enablers in place and known barriers minimised, valuable personalised conversations occurred. Reframing the conversation to focus on how someone wants to live, while including their priorities for death, could alter how such conversations are perceived by clinicians and the public. It could remove negative associations (such as linking these conversations with an imminent death), which may increase motivation for all to initiate discussions.ACP conversations are evidenced best practice and could become routine in general practice with adjustments to practice processes and clinician education; the Daffodil Standards facilitate continued quality improvement.
摘要：
预先护理计划(ACP)是一个讨论的过程，反思和沟通，能够规划未来的医疗。尽管有证据表明ACP对患者有益，家庭和医疗保健系统，许多人在没有机会进行这种对话的情况下死亡，特别是那些患有进行性非恶性疾病的人。2020年推出的皇家全科医师学院和玛丽居里水仙花标准为初级保健提供了改善临终关怀的结构。包括ACP的交付。主动识别患者是该方法不可或缺的。我们报告了一个质量改进项目，该项目旨在使用“对您重要的事情”（WMTY）框架评估及时和个性化ACP对话的一般实践中的接受率和可接受性。并确保包括不同的诊断和人口统计学群体。以前没有ACP并且可能在生命的最后一年的患者被提供了ACP对话；一项调查寻求反馈。81%的人接受了这个提议，在大多数情况下，在格洛斯特郡使用公认的格式记录未来的护理指导，以记录ACP对话，急诊护理和治疗（ReSPECT）计划的推荐摘要。临床医生和患者满意度很高。我们得出的结论是，使用“WMTY”格式的ACP讨论对于大多数人来说是高度可接受的。随着公认的推动者到位，已知的障碍最小化，有价值的个性化对话发生。把谈话的焦点放在某人想要如何生活上，同时包括他们对死亡的优先考虑，可能会改变临床医生和公众对这种对话的看法。它可以消除负面关联（例如将这些对话与即将死亡联系起来），这可能会增加所有人发起讨论的动力。ACP对话是证明的最佳实践，并且可以通过调整实践过程和临床医师教育而成为一般实践的常规；水仙花标准促进了持续的质量改进。
