Planning for the end of life: the views of older people about advance care statements

被引:120
作者
Seymour, J
Gott, M
Bellamy, G
Ahmedzai, SH
Clark, D
机构
[1] Univ Sheffield, Palliat & End Life Care Res Grp, Sch Nursing & Midwifery, Sheffield S3 7ND, S Yorkshire, England
[2] Univ Sheffield, No Gen Hosp, Sheffield Inst Studies Ageing, Div Clin Sci,Community Sci Ctr, Sheffield S5 7AU, S Yorkshire, England
[3] Univ Sheffield, Royal Hallamshire Hosp, Acad Unit Palliat Med, Sheffield S10 2JF, S Yorkshire, England
[4] Univ Lancaster, Inst Hlth Res, Lancaster LA1 4YTU, England
基金
英国经济与社会研究理事会;
关键词
advance statements; end-of-life care; older people; UK;
D O I
10.1016/j.socscimed.2003.10.005
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 [公共卫生与预防医学]; 120402 [社会医学与卫生事业管理];
摘要
Advance statements about medical care have been heralded by some as a solution to the problem of end of life decision making for people not able to participate in discussions about their care. Since death is now most likely to occur at the end of a long life, it is important to understand the views and values which older people express in relation to these. This paper reports on a study which used focus groups to explore older people's views about advance statements and the role these might play in end of life care decisions. Participants were 32 older people or their representatives who belonged to six diverse community groups in Sheffield, UK. Advance statements were understood primarily in terms of their potential to aid personal integrity and to help the families of older people by reducing the perceived 'burden' of their decision making. However, concerns were expressed about the perceived link between advance care statements and euthanasia, their future applicability, and the possibility that preferences for care may change. Participants also reported worries and difficulties related to thinking about and discussing death and dying. Trust between doctor and patient, built up over time, was perceived to be important in creating an environment in which the communication necessary to underpin advance care planning could take place. Lastly, participants did not perceive that during dying they would be ready necessarily to adhere to an advance statement and 'disengage' from their lives. We conclude that, rather than emphasising the completion of advance statements, it may be preferable to conceptualise advance care planning as a process of discussion and review between clinicians, patients and families. (C) 2003 Elsevier Ltd. All rights reserved.
引用
收藏
页码:57 / 68
页数:12
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