To improve the quality of advance care planning (ACP) in primary care, it is important to understand the frequency of and topics involved in the ACP discussion between patients and their family physicians (FPs). A secondary analysis of a previous multicenter cross-sectional observational study was performed. The primary outcome of this analysis was the frequency of and topics involved in the ACP discussion between outpatients and FPs. In March 2017, 22 family physicians at 17 clinics scheduled a day to assess outpatients and enrolled patients older than 65 years who were recognized by FPs as having regular visits. We defined three ACP discussion topics: 1) future decline in activities of daily living (ADL), 2) future inability to eat, and 3) surrogate decision makers. FPs assessed whether they had ever discussed any ACP topics with each patient and their family members, and if they had documented the results of these discussions in medical records before patients were enrolled in the present study. We defined patients as being at risk of deteriorating and dying if they had at least 2 positive general indicators or at least 1 positive disease-specific indicator in the Japanese version of the Supportive and Palliative Care Indicators Tool. In total, 382 patients with a mean age of 77.4 ± 7.9 years were enrolled, and 63.1% were female. Seventy-nine patients (20.7%) had discussed at least one ACP topic with their FPs. However, only 23 patients (6.0%) had discussed an ACP topic with family members and their FPs, with the results being documented in their medical records. The topic of future ADL decline was discussed and documented more often than the other two topics. Patients at risk of deteriorating and dying discussed ACP topics significantly more often than those not at risk of deteriorating and dying (39.4% vs. 16.8%, p < 0.001). FPs may discuss ACP with some of their patients, but may not often document the results of this discussion in medical records. FPs need to be encouraged to discuss ACP with patients and family members and describe the decisions reached in medical records.

中文翻译：

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讨论和记录初级保健中的高级护理计划的频率：多中心横断面观察性研究的二级分析

为了提高初级保健中的预先护理计划（ACP）的质量，重要的是要了解患者及其家庭医生（FP）之间进行ACP讨论的频率和主题。对先前的多中心横截面观察性研究进行了二级分析。该分析的主要结果是门诊患者和FP之间ACP讨论的频率和主题。2017年3月，有17家诊所的22位家庭医生安排了一天的活动，以评估门诊病人和65岁以上被FP认可为定期就诊的患者。我们定义了三个ACP讨论主题：1）未来日常生活活动的减少（ADL），2）未来无法进食以及3）替代决策者。FPs评估了他们是否曾经与每位患者及其家人讨论过任何ACP主题，以及他们是否在患者纳入本研究之前在医疗记录中记录了这些讨论的结果。如果日语版的“支持和姑息治疗指标工具”中的至少2项一般总体指标或至少1项特定于疾病的阳性指标，我们将患者定义为有恶化和死亡风险。总共招募了382名平均年龄为77.4±7.9岁的患者，女性为63.1％。79名患者（20.7％）与他们的FP讨论了至少一个ACP主题。但是，只有23名患者（6.0％）与家庭成员及其FP讨论了ACP主题，其结果记录在他们的病历中。与其他两个主题相比，讨论和记录未来ADL下降的主题的频率更高。与没有恶化和死亡风险的患者相比，有恶化和死亡风险的患者讨论ACP主题的频率更高（39.4％vs. 16.8％，p <0.001）。FP可能会与其一些患者讨论ACP，但可能不会经常在医疗记录中记录此讨论的结果。需要鼓励FP与患者及其家人讨论ACP并描述病历中做出的决定。但可能不会经常在医疗记录中记录这次讨论的结果。需要鼓励FP与患者和家人讨论ACP并描述病历中做出的决定。但可能不会经常在医疗记录中记录这次讨论的结果。需要鼓励FP与患者及其家人讨论ACP并描述病历中做出的决定。