目的:现有的与提前护理计划(ACP)相关的系统评价主要集中在特定的人群和干预效果上,或者仅限于环境因素。这项研究旨在确定在医疗机构中ACP的不同用户所感知的可修改因素,并告知医疗保健专业人员影响ACP实践的因素。
方法:五个英语数据库(ProQuest,PubMed,CINAHLPlus,Scopus,和Medline)和两个中文数据库(CNKI和NCL)进行了搜索,直到2022年11月。包括在医疗机构中确定与ACP相关因素的实证研究。ACP被定义为关于未来临终关怀的讨论过程。对所有纳入的研究进行主题合成。
结果:共筛选了1871篇独特文章;193篇全文由4位审稿人评估,并纳入45篇文章进行分析。22项(54%)研究是定性的,15(33%)是定量的,和6(13%)使用混合方法。焦点在单个受试者组的28项(62%)研究中有所不同(任一患者,家庭,或医师),2个主题组(患者和家庭或患者和医疗保健专业人员)中的11个(25%),6个(13%)涵盖了3个受试者组(患者,家庭,和医疗保健专业人员)。在涉及1个以上主题组的17项研究中,只有2个在分析中采用了二进透镜。复杂的交织因素分为(1)内部因素,(2)人际关系因素,(3)社会环境因素,共有11个主题:个人信仰,情感,别人的负担,定时,响应性、响应性关系,家庭动态,经验,带头的人,文化,和支持。
结论:患者,家庭,和医疗保健专业人员是ACP在医疗保健环境中的重要利益相关者。内部因素交织在一起,人际关系,和社会环境层面。有必要进行研究,以从多维角度检查三个基本利益相关者的动态相互作用,以及因素交织的机理。
OBJECTIVE: Existing systematic reviews related to advance care planning (ACP) largely focus on specific groups and intervention efficacy or are limited to contextual factors. This research aims to identify the modifiable factors perceived by different users of ACP in healthcare settings and inform healthcare professionals about the factors affecting ACP practice.
METHODS: Five English-language databases (ProQuest, PubMed, CINAHL Plus, Scopus, and Medline) and two Chinese-language databases (CNKI and NCL) were searched up to November 2022. Empirical research identifying factors related to ACP in healthcare settings was included. ACP is defined as a discussion process on future end-of-life care. Thematic synthesis was performed on all included studies.
RESULTS: A total of 1871 unique articles were screened; the full texts of 193 were assessed by 4 reviewers, and 45 articles were included for analysis. Twenty-two (54%) studies were qualitative, 15 (33%) were quantitative, and 6 (13%) used mixed methods. Foci varied from 28 (62%) studies on a single subject group (either patient, family, or physician), 11 (25%) on 2 subject groups (either patient and family or patient and healthcare professional), and 6 (13%) covered 3 subject groups (patient, family, and healthcare professional). Among the 17 studies involving more than 1 subject group, only 2 adopted a dyadic lens in analysis. Complex interwoven factors were categorized into (1) intrapersonal factors, (2) interpersonal factors, and (3) socio-environmental factors, with a total of 11 themes: personal belief, emotions, the burden on others, timing, responsiveness, relationship, family dynamics, experience, person taking the lead, culture, and support.
CONCLUSIONS: Patients, families, and healthcare professionals are the essential stakeholders of ACP in healthcare settings. Factors are interweaved among the intrapersonal, interpersonal, and socio-environmental dimensions. Research is warranted to examine the dynamic interactions of the 3 essential stakeholders from a multidimensional perspective, and the mechanism of the interweaving of factors.