痴呆症患者预立医疗照护计划干预策略的研究新进展

doi:10.12114/j.issn.1007-9572.2023.0615

摘要/Abstract

摘要： 预立医疗照护计划旨在让个体在还具有决策能力时，提前与家庭成员和医务人员讨论关于未来医疗、护理决策的目标、偏好，使个体在其决策能力丧失时得到符合其偏好的医疗照护。我国预立医疗照护计划在痴呆症群体中的实施尚处于萌芽阶段，本文旨在了解痴呆症人群中预立医疗照护计划干预策略的研究进展，为我国痴呆症人群开展预立医疗照护计划提供理论参考。本研究通过检索国内外相关数据库，对痴呆症患者预立医疗照护计划概念、干预策略及干预注意事项进行综述。本文发现现有研究表明了预立医疗照护计划在痴呆症患者中的益处；干预多以面对面结构化讨论为主要方式，内容涉及痴呆症患者对疾病的理解、未来护理目标及护理偏好；干预注意事项主要包括实施时机、痴呆症患者决策能力评估、促进家属参与和干预实施者培训。痴呆症人群中预立医疗照护计划的实施整体有积极意义，但大多干预实施策略的长期有效性还需进一步研究。

关键词: 痴呆, 脑疾病, 预立医疗照护计划, 干预策略, 老年人, 综述

Abstract:

Advance care planning aims to allow individuals to discuss their goals and preferences for future medical and nursing care with family members and medical personnel in advance when they still have decision-making ability, so that individuals can receive medical care that meets their preferences when they lose their decision-making ability. Advance care planning in dementia population in China is still in infancy, this study aims to explore the research progress of advance care planning in dementia population, and provide theoretical references for the implementation of advance care planning in China.Relevant domestic and international databases were searched to provide an overview of the concept of advance care planning, intervention strategies, and intervention considerations for dementia patients. This review found that existing studies demonstrated the benefits of advance care planning in dementia patients; the intervention strategies were mostly based on face-to-face structured discussions about the understanding of disease, future goals of care, and care preferences of dementia patients, and the intervention considerations mainly included the timing of implementation, assessment of the decision-making capacity of dementia patients, promotion of family involvement, and training of the intervention implementer. The implementation of advance care planning in dementia population had been demonstrated to be positive overall, but the long-term effectiveness of most intervention implementation strategied requires further research.

Key words: Dementia, Brain diseases, Advance care planning, Strategies, Aged, Review

张曦,管成果,王婧,等. 痴呆症患者预立医疗照护计划干预策略的研究新进展[J]. 中国全科医学, 2025, 28(32): 4109-4116. DOI: 10.12114/j.issn.1007-9572.2023.0615.
ZHANG Xi,GUAN Chengguo,WANG Jing, et al. Advances in Intervention Strategies for Advance Care Planning in Dementia Patients[J]. Chinese General Practice, 2025, 28(32): 4109-4116. DOI: 10.12114/j.issn.1007-9572.2023.0615.

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