Study On The Construction Of Communication Documentation Of Advance Care Planning For Critically Ill Patients

Objective: Based on the views and suggestions of medical staff on ACP communication documentation and the medical decision-making experience of patients and families,scientific and practical ACP communication documentation for critically ill patients are constructed,thereby improving the existing clinical communication problems between critically ill doctors and patients in China.Methods: This study is mainly divided into three phases.The first stage,the convenient sampling method was used to extract the critical illness and critical illness notices of the tertiary general hospitals in China and extract their core elements,and at the same time,the core elements of the ACP document that have a similar effect to the notice of critical illness and severe illness in China were extracted,so as to provide a reference for the construction of the ACP communication document.The second stage,a semi-structured face-to-face interview was conducted with the medical staff and patients and their families of two tertiary general hospitals to understand the views and suggestions of the medical staff on the ACP communication documents,and the medical decision-making experience of patients and their families.The third stage,delphi expert consultation method was used to construct ACP communication documents for critically ill patients based on literature review,current situation research and qualitative interview results.Results: 1.In addition to the title,the content of the Critical Illness Notice includes 8specific contents: basic information of the patient,preamble,complications that endanger the patient’s life,other information,the opinion of the patient’s family or the patient’s legal guardian(authorized client),the following 3 items are the signatures of the patient’s family member or the patient’s legal guardian(authorized client)and the medical staff.The POLST includes 7 specific items of the medical order for life maintenance treatment: basic information of the patient,cardiopulmonary resuscitation,medical treatment,and artificial nutrition,and the next 3 items are the three signatures and dates of the doctor and patient.2.The views and suggestions of medical staff on the communication documents for critically ill patients to pre-establish medical care plans mainly include three themes: attitudes toward ACP communication documentation,content requirements of ACP communication documents,and key points for the implementation of ACP communication documents.The decision-making experience of critically ill patients and their families mainly includes three themes: lack of awareness of decision sharing,lack of disease-related knowledge and decision-making participation needs.3.After two rounds of expert consultation,the mean value of importance of the entries range from 3.87 to 5.00,the frequency of full score of importance of the entries range from 26.67%to 100%,the mean value of importance and the full score of importance met the entry criteria,indicating a high degree of concentration of opinions of consulting experts;The Kandall coefficient of concordance of item importance is 0.392,Chi-square test shows that the results are statistically significant(P < 0.001),and the coefficient of variation of each item is less than 0.25(0 ～ 0.224),experts tend to agree,and the final scheme contains 6 dimensions and24 items.Conclusion: Critically ill patient ACP communication documentation are not only integrated into the core content of China’s critical illness notice,but also into the core content of ACP discussion,through expert consultation and continuous fine specification,with scientific and feasibility,can provide reference for the promotion and application of ACP communication documents in China’s critically ill patients in the future.