Confrontational but important – A mixed-methods evaluation of the MUTUAL (Multidisciplinary timely undertaken advance care planning) intervention

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling Pub Date : 2025-06-06 DOI:10.1016/j.pec.2025.109214

Eline VTJ van Lummel , Emma PE Maats , Elena P. Kenswil , Dave HT Tjan , Johannes JM van Delden , Megan Milota

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Abstract

Introduction

The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention was developed to facilitate early initiated and structured advance care planning (ACP) at outpatient clinics. This study explores stakeholder evaluations of MUTUAL after its implementation.

Methods

A sequential explanatory mixed-methods study was conducted at seven outpatient clinics at one non-academic Dutch hospital. Patients, nurses, and physicians completed questionnaires after participating in an ACP conversation. Quantitative analysis of the questionnaire results was supplemented by a qualitative analysis of open comments, and semi-structured interviews were conducted with patients and proxies.

Results

For 216 ACP conversations, responses were received from 121 patients (response rate 57.9 %) and from 136 nurses and 116 physicians (response rates 65.1 % and 55.5 %). Overall, 80.1 % of conversations were evaluated by at least one stakeholder. All stakeholders rated the ACP conversations as worthwhile (4.6–4.8 out of 5) and expressed satisfaction (scores of 8.6, 7.8, and 8.3 out of 10 for patients, nurses, and physicians, respectively). Three themes were identified. First, we found a diversity of patient paths within the ACP process. MUTUAL facilitated reflection and open dialog at various stages, leading to valuable discussions despite sometimes confrontational end-of-life topics. Second, stakeholders had varying perspectives on what makes the ACP conversation valuable. Some HCPs emphasize the importance of making treatment decisions. Others value the opportunity to address patient concerns even without changes to the treatment decisions of the patient. Third, having time and a structured setting outside regular outpatient consultations fostered trust and openness; HCPs’ empathy and expertise were appreciated, seemingly regardless of prior established relationships.

Conclusion

MUTUAL was positively received by stakeholders, even when evoking mixed emotions. By encouraging broader discussions beyond immediate treatment decisions, the intervention promoted reflection, reassurance, and ongoing conversations. Findings support an adaptable, multi-stakeholder ACP approach in which HCPs act as guiding partners for patients during their (chronic) illness journeys.

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对抗性但重要- MUTUAL（多学科及时开展的预先护理计划）干预的混合方法评估

多学科及时开展的提前护理计划（MUTUAL）干预措施是为了促进门诊诊所早期启动和结构化的提前护理计划（ACP）。本研究探讨互惠互惠实施后的利益相关者评价。方法在荷兰一家非学术性医院的7个门诊进行顺序解释性混合方法研究。患者、护士和医生在参与ACP对话后完成问卷调查。对问卷结果进行定量分析的同时，对公开评论进行定性分析，并对患者和代理人进行半结构化访谈。结果在216次ACP对话中，收到了121名患者（回复率为57.9 %）、136名护士和116名医生（回复率为65.1% %和55.5% %）的回复。总体而言，80.1 %的对话至少由一个涉众评估。所有利益相关者都认为ACP对话是值得的（4.6-4.8分，满分5分），并表示满意（患者、护士和医生的得分分别为8.6、7.8和8.3分，满分10分）。确定了三个主题。首先，我们发现ACP过程中患者路径的多样性。MUTUAL促进了不同阶段的反思和开放对话，导致了有价值的讨论，尽管有时会有对抗性的临终话题。其次，利益相关者对ACP对话的价值有不同的看法。一些卫生保健提供者强调作出治疗决定的重要性。另一些医生则重视在不改变病人治疗决定的情况下解决病人问题的机会。第三，在常规门诊咨询之外，有时间和有组织的环境可以促进信任和开放；医护人员的同理心和专业知识受到赞赏，似乎与之前建立的关系无关。即使在引起复杂情绪的情况下，mutual也得到了利益相关者的积极认可。通过鼓励更广泛的讨论，而不是直接的治疗决定，干预促进了反思、安慰和持续的对话。研究结果支持一种适应性强的多利益相关者ACP方法，在这种方法中，HCPs在患者的（慢性）疾病旅程中充当指导伙伴。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Patient Education and Counseling 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.60

自引率

11.40%

发文量

384

审稿时长

46 days

期刊介绍： Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.