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Advance Care Planning in terminally ill and frail older persons

机译：身患绝症和虚弱老年人的预先护理计划

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Objective: Advance Care Planning (ACP) - the communication process by which patients establish goals and preferences for future care - is encouraged to improve the quality of end-of-life care. Gaining insight into the views of elderly on ACP was the aim of this study, as most studies concern younger patients. Methods: We conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis. Results: The majority of participants were willing to talk about dying. In some elderly, however, non-acceptance of their nearing death made ACP conversations impossible. Most of the participants wanted to plan those issues of end-of-life care related to personal experiences and fears. They were less interested in planning other end-of-life situations being outside of their power of imagination. Other factors determining if patients proceed to ACP were trust in family and/or physician and the need for control. Conclusions: ACP is considered important by most elderly. However, there is a risk of pseudo-participation in case of non-acceptance of the nearing death or planning end-of-life situations outside the patient's power of imagination. This may result in end-of-life decisions not reflecting the patient's true wishes. Practice implications: Before engaging in ACP conversations, physicians should explore if the patient accepts dying as a likely outcome. Also the experiences and fears concerning death and dying, trust and the need for control should be assessed.
机译：目标：鼓励提前护理计划（ACP）–患者建立未来护理目标和喜好的沟通过程–改善临终护理的质量。由于大多数研究都针对年轻患者，因此深入了解老年人对ACP的看法是本研究的目的。方法：我们对38例预后有限的老年患者进行了半结构化访谈。结果：大多数参与者愿意谈论死亡。然而，在一些老年人中，由于无法接受即将死亡的消息，因此无法进行ACP对话。大多数参与者都想计划与个人经历和恐惧有关的临终关怀问题。他们对计划其他超出其想象力的寿命终止情况的兴趣不大。决定患者是否进行ACP的其他因素是对家庭和/或医生的信任以及对控制的需求。结论：ACP被大多数老年人认为很重要。但是，如果不接受临近的死亡或在患者的想象力范围之外计划寿命末期情况，则存在伪参与的风险。这可能导致生命周期决定无法反映患者的真实意愿。实践意义：在进行ACP对话之前，医生应探讨患者是否接受死亡作为可能的结果。还应评估有关死亡和垂死，信任和控制需要的经验和恐惧。

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