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首页> 外文期刊>Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer >A mixed methods analysis of patients' advance care planning values in outpatient oncology: Person-Centered Oncologic Care and Choices (P-COCC)
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A mixed methods analysis of patients' advance care planning values in outpatient oncology: Person-Centered Oncologic Care and Choices (P-COCC)

机译：门诊肿瘤内患者预防规划价值的混合方法分析：以人为本的肿瘤护理和选择（P-COCC）

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Purpose Person-Centered Oncologic Care and Choices (P-COCC) combines an advance care planning (ACP) value-focused patient interview with a care goal video decision aid. Our randomized study showed that P-COCC was acceptable but increased participant distress, compared with video-alone and usual care study arms. This mixed methods approach explores the ACP values in the P-COCC arm and their relationship to the distress phenomenon. Methods Qualitative thematic analysis of the 46 audio-recorded P-COCC interview transcripts with advanced gastrointestinal cancer patients was performed by multiple reviewers. Quantitative (Likert scale) changes in ACP values were compared across study arms. ACP themes and value change were analyzed in participants with increased distress. Results Transcript analysis resulted in thematic saturation and identified eight distinct themes on ACP values relating to end-of-life wishes, communication needs, and psychosocial supports. Of 98 participants (33 P-COCC, 43 videos, 22 usual care) who completed the change in value measure, there was no difference detected with P-COCC compared with either video (p = 0.052) or usual care (p = 0.105) arms alone, but P-COCC led to a frequency distribution of more change in personal values compared with the other study arms combined (p = 0.043). Among the subset of P-COCC participants with increased distress, there was no statistical relationship with change in values. Conclusions The ACP paradigm P-COCC both informs and supports patients in individualized, value-based decision-making. Distress is not associated with changes in ACP values and may be a necessary, at least transient, byproduct of discussing sensitive but pertinent topics about end-of-life medical care.
机译：目的是以人为本的肿瘤护理和选择（P-COCC）结合了先进的护理计划（ACP）价值的患者面试，并考虑了护理目标视频决策援助。我们的随机研究表明，与视频单独和通常的护理研究武器相比，P-COCC是可接受的，但增加参与者痛苦。这种混合方法方法探讨了P-COCC臂中的ACP值及其与遇险现象的关系。方法采用多次审查员进行46名音频记录的P-COCC访谈转录物的定性专题分析。在研究武器中比较了ACP值的定量（李克特量表）变化。在参与者中分析了ACP主题和价值变化，增加了痛苦。结果转录分析导致主题饱和度，并确定了与寿命结束愿望，通信需求和心理社会支持有关的ACP值的八个不同主题。在98名参与者（33个P-COCC，43个视频，22种常规护理）中完成了价值措施的变化，与视频（P = 0.052）或常规护理（P = 0.105）没有检测到P-COCC的差异（P = 0.105）单独武器，但与其他研究臂组合相比，P-COCC导致个人价值更大的频率分布（P = 0.043）。在P-COCC参与者的子集中，随着遇险的增加，与价值的变化没有统计关系。结论ACP范式P-COCC都通知和支持个性化价值的决策患者。遇险与ACP值的变化无关，并且可能是必要的，至少暂行，副产品讨论敏感，但有关寿命结束医疗保健的相关话题。

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