RESUMO
BACKGROUND AND AIMS: Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process. METHODS: In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process. RESULTS: The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice. CONCLUSION: To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575.
Assuntos
Planejamento Antecipado de Cuidados , Tomada de Decisões , Humanos , Tomada de Decisão Compartilhada , Registros , Documentação , Participação do PacienteRESUMO
The Patient-Centered Emergency Plan - Practical Experiences Abstract. Most people in Switzerland wish to die at home. This practical report shows how the cooperation of family physicians and a specialized palliative care team as well as the application of an emergency plan individually adapted to the general goal of care and the basic illness of the patient can support the realization of this wish. Good coordination of advance care planning through an individualized patient-centered emergency plan as well as the joint implementation of this care by the interdisciplinary, multiprofessional treatment team and the organization of a good care network are essential components to avoid unwanted emergency hospitalizations at the end of life.
Assuntos
Planejamento Antecipado de Cuidados , Hospitalização , Humanos , Motivação , Cuidados Paliativos , Assistência Centrada no Paciente , SuíçaRESUMO
Advance Care Planning in Swiss Nursing Homes: Results of a Focus Group Study Abstract. Advance Care Planning (ACP) is a standardized consultation process in which patients define their therapy goals for future medical treatments with the help of a qualified health care facilitator. This way, ACP increases the probability that patients' wishes are fulfilled in case of decisional incapacity. The aim of this study was to implement a previously tested Swiss ACP program in two Swiss nursing homes to better understand the resulting processes, chances and difficulties. For this purpose focus group interviews were conducted after first implementation steps. The results show that an ACP implementation needs and must be coordinated with an approach covering the entire health system.
