Finding the balance between person-centred and treatment-centred discussions in advance care planning-a qualitative analysis of conversations within the MUTUAL (Multidisciplinary Timely Undertaken Advance Care Planning conversations) intervention using a narrative analysis

被引：2

作者：

van Lummel, Eline V. T. J. ^{[1
,2
]}

Ietswaard, Larissa ^{[2
]}

Rigter, Marloes ^{[2
]}

Tjan, Dave H. T. ^{[1
]}

van Delden, Johannes J. M. ^{[2
]}

Milota, Megan ^{[2
]}

机构：

[1] Gelderse Vallei Hosp, Dept Intens Care, Ede, Netherlands

[2] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Dept Bioeth & Hlth Humanities, Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands

来源：

AGE AND AGEING | 2024年 / 53卷 / 03期

关键词：

advance care planning; person-centred care discussions; treatment-centred care discussions; narrative analysis; qualitative research; older people; COMMUNICATION;

D O I：

10.1093/ageing/afae020

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

Introduction Advance care planning (ACP) aims to create conditions for more person-centred care. We aimed to explore variations in person-centred care discussions and treatment-centred care discussions within ACP conversations in the Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention and how person-centred care discussions could be encouraged. The MUTUAL intervention consists of the following: (i) timely patient selection, (ii) the patient and healthcare professionals preparing for the conversation, (iii) a scripted ACP conversation in a multidisciplinary setting and (iv) documentation.Methods We conducted a narrative analysis of ACP conversations. A narrative summary template was created and used to analyse 18 audio-recordings.Results We noticed variations in person-centred and treatment-centred focus within the ACP conversations. We identified three important strategies that facilitated person-centred care discussions within ACP conversations. First, healthcare professionals' acceptance that ACP is an individual process. We believe it is important that healthcare professionals recognise and accept where the patient is in his or her individual ACP process; not making decisions right away can also be part of a decisional process. Secondly, exploring the underlying motivation for treatment wishes can give insights into patient's wishes, values and needs. Lastly, healthcare professionals who demonstrated an adaptive, curious and engaged attitude throughout the ACP process achieved more person-centred ACP conversations. This coincided with elaborating on the patient's emotions, fears and worries.Conclusion Person-centred and treatment-centred focus varied within the ACP conversations in the MUTUAL intervention. Certain strategies by healthcare professionals facilitated a more person-centred focus.

引用

页数：9

共 5 条

[1] The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention
van Lummel, Eline V. T. J.
Savelkoul, Claudia
Stemerdink, Eva L. E.
Tjan, Dave H. T.
van Delden, Johannes J. M.
BMC PALLIATIVE CARE, 2022, 21 (01)
[2] The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention
Eline V. T. J. van Lummel
Claudia Savelkoul
Eva L. E. Stemerdink
Dave H. T. Tjan
Johannes J. M. van Delden
BMC Palliative Care, 21
[3] Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study
Eline V. T. J. van Lummel
Yoeki Meijer
Dave H. T. Tjan
Johannes J. M. van Delden
BMC Palliative Care, 22
[4] Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study
van Lummel, Eline V. T. J.
Meijer, Yoeki
Tjan, Dave H. T.
van Delden, Johannes J. M.
BMC PALLIATIVE CARE, 2023, 22 (01)
[5] The interactive work of narrative elicitation in person-centred care: Analysis of phone conversations between health care professionals and patients with common mental disorders
Cederberg, Matilda
Fors, Andreas
Ali, Lilas
Goulding, Anneli
Makitalo, Asa
HEALTH EXPECTATIONS, 2022, 25 (03) : 971 - 983

← 1 →