探讨严重虚弱的诊断是否会引发预先护理规划和生命末期护理对话。

Stacey Dodson
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引用次数: 0

摘要

背景:体弱的老年人很容易出现突然和迅速的病情恶化,因此,讨论他们在生命末期的护理意愿和偏好应该是一个优先事项。目的:探讨资深医护人员对临床虚弱量表(CFS)在识别虚弱方面的作用的看法和观点;CFS评分为严重虚弱时,资深医护人员是否会意识到患者很可能已接近生命末期;CFS评分为严重虚弱时,资深医护人员是否会与患者就预先护理计划和生命末期护理进行交谈:方法:对英格兰一家医院的七名高级医护人员进行了半结构化个人访谈。采用主题分析法对数据进行分析:虚弱似乎是复杂的、多方面的,有时难以识别。严重虚弱的诊断并不一定会促使进行预先护理规划和生命末期护理谈话。如果患者患有癌症等并发症,则更有可能进行此类谈话。预诊似乎具有挑战性,部分原因是体弱的轨迹是渐进的、不确定的,而且医护人员对体弱及其影响缺乏了解:结论:严重体弱者在接受适当的临终关怀方面可能处于不利地位。加强对所有医护人员的虚弱教育将有助于与被诊断为严重虚弱的患者就预先护理计划和生命末期护理进行交流。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring whether a diagnosis of severe frailty prompts advance care planning and end of life care conversations.

Background: Older people with frailty are susceptible to sudden and rapid deterioration, so discussing their wishes and preferences for care at the end of life should be a priority. However, frailty is often not considered or recognised, which impedes patient-centred decision-making.

Aim: To explore the views and perceptions of senior healthcare professionals regarding the usefulness of the Clinical Frailty Scale (CFS) in identifying frailty; whether a CFS score of severe frailty leads senior healthcare professionals to recognise that the person is likely to be approaching the end of life; and whether a CFS score of severe frailty prompts senior healthcare professionals to have conversations about advance care planning and end of life care with patients.

Method: Semi-structured individual interviews were undertaken with seven senior healthcare professionals at one hospital in England. Data were analysed using thematic analysis.

Findings: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects.

Conclusion: People with severe frailty may be disadvantaged in terms of receiving appropriate end of life care. Better education on frailty for all healthcare professionals would facilitate conversations about advance care planning and end of life care with patients diagnosed with severe frailty.

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