A study of current status of acceptance and influencing factors of advance care planning for patients with malignant tumors

Objective:To assess the ACP acceptance among patients with malignant tumor in China and factors affecting adoption and timing.Methods:Quantitative study:The convenience sampling method was adopted from October 2020 to October 2021 to investigate 200 oncology patients by a general information questionnaire,patient's advance care planning acceptance questionnaire(ACPQ).Multiple linear stepwise regression was used to analyze the influencing factors of ACP acceptance.Qualitative study:A purposive sampling method was used to select 31 oncology patients and 13 clinical nurses for semi-structured interviews.The data were analyzed using Colaizzi's seven steps.Results:The quantitative study revealed that patients with malignancy had an upper-middle acceptance score of(66.15±7.684)for ACP,with attitude(11.26±2.064),feelings(36.64±4.208),and intention(18.25±3.275)scores.Multiple linear regression analysis showed that religious beliefs,education,monthly income,bereavement experience and notification of condition were independent risk factors for acceptance of ACP(P<0.05).The qualitative study showed that(1)oncology patients have low awareness,high demand,and low acceptability of ACP intervention;(2)they preferred to discuss ACP when medical condition or treatment plan changes;(3)family members were usually involved in ACP discussions,followed by medical personnel;(4)economy,environment,companion,and doctor-patient relationship will all influence ACP implementation.As for nurses,they(1)were unsure about the dynamic changes of ACP content and its optimal timing;(2)had limited ACP knowledge;(3)were affected by environmental factors and nurse-patient relationships;(4)were prone to have disagreements due to inadequate organization department assistance.Conclusions:clinical practitioners should discuss ACP with patients in specific conditions to increase patient acceptance.ACP development requires updated legislation,professional training,and a standardized ACP system.

Advance care planning readiness for Chinese older people:An integrative review and conceptual framework

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration.Readiness for advance care planning is a patient's preparedness to engage in advance care planning.This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people.The current knowledge from the published studies was identified and synthesized by an integrative review.The conceptual framework was developed based on the social-ecological model and the theory of planned behavior.The factors from the social environment/community,health care professionals,and individual/family layers were defined.These factors may influence an individual's medical decision-making,which in turn triggers individual behavioral mechanisms that arise from interactions between motivations,attitudes,and beliefs.Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning par ticipation in China.This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people,and to design intervention studies to test the effect of family function on the readiness for advance care planning.

Visual analysis of advance care planning related studies

Backgroud:To provide a reference for the further development of the field of the advance care planning(ACP),through the visual analysis of the related literature on the ACP.Methods:Taking the core collection database of Web of ScienceTM as data sources,the method of subject word retrieval is adopted.Literature metrology and CiteSpaceⅤinformation visualization software were used to analyze the literature on ACP published from inception to September 2019.Results:A total of 1,981 literature were included.The number of ACP studies increased,USA published the most literature in the world,followed by Australia,Britain,Canada and the Netherlands and so on.The most leading published journal was the Journal of Palliative Medicine,and the highest impact factor was Palliative Medicine(4.956).Sudore,Rebecca L and Hillary D Lum are the key researcher networks with the largest amount of articles published in ACP field.The research content mainly included the definition,implementation process and implementation effect of ACP.Research focused on palliative care,hospice care,decision-making,communication,patient preference and so on.Conclusion:The studies on ACP is on the rise,the research content is deepening,which suggests that we can learn from the research results of foreign countries in this field and continue to deepen the research in the field of ACP in China.

The perceptions and experiences of advanced cancer patients and their families in advance care planning:a systematic review and synthesis of qualitative studies

Background:The goal of this study was to conduct a meta-synthesis of advanced cancer patients’and their relatives’experiences with advanced care planning(ACP)and to provide evidence-based guidance for the development and implementation of ACP in advanced cancer patients.Methods:We searched databases including China Knowledge Network,Wanfang database,VIP database,China Biomedical Literature Database,PubMed,Web of Science,Embase,Cochrane Library,and Cinahl from inception to April 2022 to collect qualitative studies on advanced cancer patients and families'experience about ACP.We use Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research to evaluate the quality of literature.After quality assessment,meta-synthesis was used to summarize and explain the results.Results:Eleven qualitative studies were included involving 29 results and ten categories.Three integrated themes were extracted:facilitators and barriers to the implementation of advanced medical care programs as perceived by patients and families with advanced cancer;attitudes of patients with advanced cancer and their families towards pre-existing medical care programs;suggestions from patients with advanced cancer and their families on the implementation elements of the pre-existing medical care program.Conclusion:ACP is a complex social process and influenced by many factors.It requires joint efforts of different stakeholders to achieve high-quality and successful ACP.

The effect of advance care planning in patients with dementia: a protocol of systematic review and meta-analysis

Aim:To comprehensively synthesize and compare the effect of advance care planning for dementia patients.Design:Systematic review and meta-analysis.Methods:Ten electronic databases will be searched:the Cochrane Library,PubMed,Medline,Embase,PsycINFO,CINAHL PLUS,Scopus,Web of Science,British Nursing Index,clinical Trials,and grey literature sources.Individually or cluster randomized controlled trials that evaluated advance care planning in people with dementia will be incorporated.The research screening flow diagrams will be detailed in the PRISMA flow chart.Data extraction will be carried out in Microsoft Excel 2019 independently by two researchers,any disagreements will be discussed with the third researcher and resolved.We will use the Cochrane Risk of Bias tool to assess the methodological quality.Review Manager 5.3 Software will be used for data synthesis.If sufficient data from studies are available,we will conduct a subgroup analysis of the main outcomes.Conclusion:The systematic review will combine existing trials which may contribute to more convincing conclusions,providing new ideas for medical workers to implement palliative therapy in dementia patients,and further promoting the application of advance care planning for dementia patients.

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

This study aimed to examine the effects of empowerment and education intervention to promote Advance Care Planning (ACP) for residents in a highly aged and depopulated region. The study utilized a single-group pre- and post-test design and was conducted in Osakikamijima, Hiroshima, Japan. The researchers and town officials together formed an ACP committee and created an intervention framework. An ACP workshop was held for the participants and a self-administered questionnaire was carried out before, immediately after, and 3 months after the workshop. A total of 125 residents participated in the workshop and 87 of them completed more than 80% of the questionnaire items, whose responses were analyzed as valid responses. The number of participants who completed the AD increased significantly three months after the workshop (p = 0.008). There was a slight increase in the frequency of consultation with the family, but no change was observed in terms of consultation with healthcare providers. The educational intervention in-creased the respondents’ awareness and knowledge of ACP but did not affect the autonomous decision-making process regarding end-of-life care. This strategic process of ACP empowered the residents’ awareness and attitude towards end-of-life care with an increased completion rate of AD. On the other hand, cognitive barriers remained toward communication and decision-making shared with healthcare providers. Insufficient consultation with family members also became evident. Therefore, a new intervention strategy which helps increase communication with healthcare providers needs to be formulated and guidelines for consultation with the family and others need to be prepared.

Readiness for Advance Care Planning in Older Adults: A Literature Review

Introduction: In the context of end-of-life care, interest in advance care planning (ACP) has increased as an approach that allows a person to live in the manner of his or her choosing until the end. ACP is a process of discussion among the elderly persons, family members, and medical staff. However, preparations necessary for starting ACP are not clear. In this study, we aim to clarify the readiness of ACP focusing on the elderly who are the center of end-of-life care. Methods: We reviewed the literature on the subject in the CINAHL and PubMed databases. The keywords used were “advance care planning” and “readiness”. Results: Twelve articles were selected for the final analysis. ACP readiness was broadly divided into preparations on the part of the elderly themselves, family members, and medical professionals. Conclusion: The most frequently reported factor in readiness for ACP was elderly people informing their families and physicians of their intentions. In addition, the establishment of communicative relationships among elderly persons, their family members, and medical professionals was considered readiness for commencing ACP. It was suggested that enhancing these types of readiness would help reduce the barriers to ACP, thereby facilitating its practice.

Status quo of implementation of advance care planning: a review

Optimum care for patients with a terminal illness is dependent on understanding their values,beliefs,and preferences on end-of-life issues and providing service that meets their preferences.As the only way to explore patients’living wills,advance care planning(ACP)is an important means to honor patient autonomy and respect their human rights and dignity.ACP has been recognized as a key indicator for quality palliative care and endorsed into national health systems by many high-income countries;however,it is little known in China's Mainland.China is now facing a growing aging and terminally ill population with many unmet needs for end-of-life care;therefore,it is imperative to implement ACP in China.In this review,we clarify the relevant concept and suitable population for ACP,describe the current situation of implementation in high-income countries,and provide better suggestions for the future development of ACP in the mainland of China.

决策支持框架理论干预在晚期癌症患者预立医疗照护计划中的应用

目的探讨决策支持框架理论干预在晚期癌症患者预立医疗照护计划中的应用效果。方法采用便利抽样法选取某肿瘤医院2023年3-6月收治的晚期癌症患者58例为对照组,2023年7-10月收治的同类患者58例为干预组。对照组采用常规护理方法,干预组在对照组基础上实施决策支持框架理论干预。比较两组患者预立医疗照护计划准备度与决策冲突得分情况。结果干预组患者预立医疗照护计划准备度总分及各维度得分均高于对照组,决策冲突总分及各维度得分均低于对照组,差异均有统计学意义(均P<0.05)。结论基于决策支持框架的预立医疗照护计划干预,能提高患者预立医疗照护计划准备度,降低决策冲突水平,对提高晚期癌症患者具有重要意义。

晚期癌症患者基于共享决策理论的预立医疗照护计划干预

目的探讨基于共享决策理论的预立医疗照护计划干预对晚期癌症患者的实施效果。方法将107例晚期癌症患者按入院时间分为两组,2023年5-7月收治的54例患者为对照组,2023年8-10月收治的53例患者为干预组。对照组实施常规护理干预,干预组在对照组基础上实施基于共享决策理论的预立医疗照护计划干预。干预4周后,比较两组预立医疗照护计划接受度、决策参与满意度及尊严得分。结果干预后干预组预立医疗照护计划接受度总分及各维度得分、决策参与满意度总分显著高于对照组,而尊严总分显著低于对照组(均P<0.05)。结论对晚期癌症患者实施基于共享决策理论的预立医疗照护计划干预,能提高其预立医疗照护计划接受度,改善决策参与满意度,维护临终患者尊严。

晚期胃癌患者预立医疗照护计划准备度现状及影响因素分析

目的调查晚期胃癌患者预立医疗照护计划准备度现状并分析影响因素。方法选取2023年3月-6月我院收治的晚期胃癌患者209例为研究对象,采用一般资料调查表、预立医疗照护计划准备度量表进行调查。结果晚期胃癌患者预立医疗照护计划准备度总分为(66.22±8.02)分,处于中等偏上水平;多元线性回归分析结果显示,年龄、病程、ECOG评分、文化程度是晚期胃癌患者预立医疗照护计划准备度的独立影响因素(P<0.05)。结论晚期胃癌患者预立医疗照护计划准备度处于中等偏上水平,医护人员应提高患者对ACP重要性的认识,同时关注年龄大、病程短、文化程度低、ECOG评分高的患者,促进预立医疗照护计划的普及应用。

缓和医疗中的伦理学问题

随着医疗理念的更新,缓和医疗已成为生命终末期患者照护的重要组成部分,与此同时,其所涉及的伦理学问题日益凸显。本文通过综述国内外缓和医疗伦理学相关研究,旨在梳理缓和医疗中5个关键的伦理学问题,包括讲真话、预立照护计划、维生干预的使用、缓和镇静、安乐死和协助死亡与缓和医疗的关系,为缓和医疗实践提供了伦理学视角,以期帮助从事缓和医疗的专业人员加深认知,更好地为患者及其家属提供高质量照护,同时为相关法律法规和政策的制定提供参考。

出院准备计划+安宁疗护模式对肿瘤晚期患者及主要照顾者的影响

目的 探讨出院准备计划+安宁疗护模式对肿瘤晚期患者及主要照顾者的影响。方法 选择2022年1月至12月江南大学附属医院收治的120例肿瘤晚期患者及其家属为研究对象,根据随机数字表法将其分为参照组和研究组,患者各60例,家属各60名。参照组行常规护理+出院准备计划,研究组在参照组的基础上增加安宁疗护干预。观察两组心理状态及主要照顾者心理应激和生活质量变化情况。结果 干预后,两组抑郁自评量表、焦虑自评量表评分均低于干预前,且研究组低于参照组,差异有统计学意义(P<0.05);两组主要照顾者家属应激量表评分均低于干预前,且研究组低于参照组,差异有统计学意义(P<0.05);两组主要照顾者生活质量量表评分均高于干预前,且研究组高于参照组,差异有统计学意义(P<0.05)。结论 出院准备计划+安宁疗护用于肿瘤晚期患者,可有效改善患者及其主要照顾者负面情绪,提高照顾者生活质量。

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。

基于COM-B模型晚期肺癌患者预立医疗照护计划参与度影响因素分析

目的 基于COM-B模型分析晚期肺癌患者预立医疗照护计划参与度的影响因素,为临床干预决策提供参考。方法 便利选取317例晚期肺癌患者,采用预立医疗照护计划参与问卷、预立医疗照护计划问卷、心理韧性量表等进行调查。根据COM-B模型中能力、机会、动机3维度分析晚期肺癌患者预立医疗照护计划参与度的影响因素。结果 晚期肺癌患者预立医疗照护计划参与度得分为(67.37±6.14)分。多元线性分层回归分析显示,知晓疾病诊断时间,能力因素中预立医疗照护计划知识和心理弹性,动机因素中预立医疗照护计划信念、动机、死亡态度(自然接受)、焦虑和抑郁,机会因素中社会支持是晚期肺癌患者预立医疗照护计划参与度的主要影响因素(均P<0.05),可解释总变异的50.4%。能力因素、动机因素、机会因素的新增解释量分别为18.6%、18.4%、3.4%。结论 晚期肺癌患者预立医疗照护计划参与度偏低,能力和动机因素的影响较大,机会因素的影响相对较小。医护人员需提高晚期肺癌患者预立医疗照护计划相关知识和心理弹性水平,激发预立医疗照护计划信念和动机,树立正确的死亡态度,减轻焦虑和抑郁水平,增加社会支持,以提高预立医疗照护计划的参与。

新加坡安宁疗护服务发展经验及其对我国的启示

安宁疗护是保障终末期患者善终权益,提升终末期患者生活质量的有效手段之一。新加坡安宁疗护发展迅猛,目前已逐步建成完善的安宁疗护服务体系,并在最新发布的国家死亡质量排名中位于亚洲前列。本文通过梳理新加坡安宁疗护现状,公众宣教、人才培养、慈善支持以及相关政策法律保障等方面的实践经验,最终提出我国应加强安宁疗护的社会认知、教育培养,发挥慈善团体和非政府组织的力量,提高现有安宁疗护承载力,构建安宁疗护相关制度和法律保障,以期达到实现终末期患者善终需求的目的。

晚期癌症患者预立医疗照护计划参与现状及影响因素研究

目的了解晚期癌症患者预立医疗照护计划参与现状,分析影响因素,为针对性干预提供参考。方法采用一般资料调查表、中文版预立医疗照护计划参与问卷、家庭支持量表、创伤后成长量表对349例晚期癌症患者进行调查与分析。结果患者中文版预立医疗照护计划参与总分为84.54±23.05;处于行为改变前意识阶段、思考阶段、准备阶段、行动阶段的患者比例依次为36.7%、37.2%、22.3%及3.7%。回归分析显示,文化程度、病程、替别人做过医疗决定、家庭支持、创伤后成长是患者预立医疗照护计划参与的主要影响因素(均P<0.05)。结论晚期癌症患者预立医疗照护计划参与水平处于中等偏下,仅少部分患者处于行为改变准备与行动阶段;应加强文化程度低、病程短、家庭支持及创伤后成长水平较低患者的干预与支持。

乳腺癌患者化疗期间预立医疗照护计划准备度的纵向研究

目的调查乳腺癌患者化疗期间预立医疗照护计划准备度水平的发展变化情况并分析其影响因素。方法采用纵向研究方法,招募准备首次化疗的乳腺癌患者138例,应用预立医疗照护计划准备度量表、癌症患者自我管理效能感量表分别于入院确诊后(T0)、首次化疗后(T1)、化疗中期(T2)、化疗结束后1个月(T3)4个时段对患者进行随访调查。结果T0、T1、T2、T3时间点乳腺癌患者预立医疗照护计划准备度得分分别为(68.75±13.45)分、(71.37±13.00)分、(80.11±12.46)分、(79.41±9.50)分。合并慢病、辅助化疗方式、自我管理效能感是乳腺癌患者化疗期间预立医疗照护计划准备度的影响因素(均P<0.05)。结论乳腺癌患者预立医疗照护计划准备度水平在化疗期间呈现动态变化,在客观影响因素不能改变的情况下,医护人员可通过干预患者自我管理效能感来提升患者预立医疗照护计划准备度水平。

晚期癌症患者预立医疗照护计划参与行为影响因素的系统综述

目的·系统整合晚期癌症患者预立医疗照护计划(advance care planning,ACP)参与行为的相关影响因素。方法·系统检索中国知网、万方、中国生物医学文献数据库(Sinomed)、PubMed、Cochrane Library、Embase、CINAHL、PsycINFO等数据库从建库至2022年12月有关晚期癌症患者ACP参与行为影响因素的中英文文献。由2名研究者对最终纳入的文献进行文献质量评价、内容提取和汇总,将定量研究与定性研究分别提取数据后进行整合,得到晚期癌症患者ACP参与行为的最终影响因素。并借助理论域框架,将其逐级映射至能力、机会、动机-行为(capability,opportunity,motivation-behavior,COM-B)模型。结果·共纳入21项研究,整合归纳出27个影响因素,涉及9个理论域。映射至COMB模型中的因素包括能力因素9个(ACP知识、文化程度、准确了解预后知识、知晓疾病诊断时间、先前经历、主观预期寿命、年龄、肿瘤部位、疾病症状负担)、机会因素13个(性别、婚姻状况、种族/民族、宗教信仰、未成年子女、家庭经济收入、居住地点、房屋居住类型、家庭支持、社会支持、医患关系、文化适应、是否设立临终关怀服务中心)和动机因素5个(ACP态度、ACP信念、ACP动机、焦虑抑郁、死亡态度)。其中,医患关系、宗教信仰、ACP态度、文化程度、婚姻状况、家庭支持、ACP知识、准确了解预后知识、年龄、居住地点、死亡态度、先前经历、种族/民族是对患者ACP参与行为影响较多的因素。结论·基于COM-B模型可全面归纳总结晚期癌症患者ACP参与行为的影响因素。未来研究可以上述因素为切入点,基于COM-B模型设计连续化、多方面的综合性干预措施,促进晚期癌症患者ACP参与行为实践。

基于CiteSpace对我国预立医疗照护计划研究热点的可视化分析

目的:分析近10年预立医疗照护计划(ACP)研究热点,为我国推进ACP事业提供借鉴与帮助。方法:采用CiteSpace软件对2013年1月1日—2023年4月30日收录于中国知网(CNKI)中ACP相关文献进行可视化分析。结果:ACP研究发文量总体呈上升趋势,形成以邓仁丽、李嘉音为核心的作者合作群,研究机构以郑州大学护理与健康学院发文最多(12篇)。该领域的研究热点归纳为3个方面:研究方式主要是质性研究;研究对象聚焦于晚期癌症病人及老年人;研究内容主要是病人ACP准备度、医护人员对ACP的认知与实践、缓和医疗事业、影响因素。结论:ACP研究在国内护理领域发文量整体呈增长趋势,但研究机构和作者合作较为薄弱,提示今后应加强合作,对研究热点及研究前沿进行深入挖掘,改善终末期病人生命质量。