亀田メディカルセンター　疼痛・緩和ケア科　「緩和ケア革命宣言」

皆様、本年もどうぞよろしくお願い致します！
当科を長年指導くださっている、UCSF老年医学/緩和ケア科のSandra Moody先生が、ACPの新概念であるadaptive care planningを提唱する論文をAmerican Geriatric Societyの学会誌に出されました。

ACPについては、近年ACP先進国である欧米でその限界の議論が多くなっており、ぜひ、皆さんと、この新概念が患者・家族ケアにどんな変化を与えるのか考えたいと思います。

https://pubmed.ncbi.nlm.nih.gov/38193787/

Abstract
A key challenge of implementing advance care planning lies in the fact that decisions made in advance require patients and their family members to imagine what their clinical picture will look like rather than knowing or experiencing the clinical circumstances as they unfold. Even more important is the acknowledgment of the unpredictability of a given clinical course. This type of situation requires adaptiveness and flexibility in decision-making that frequently occurs in the moment(s) triggered by changes in health state(s). We describe an alternative frameshifting approach called "Adaptive Care Planning (AdaptCP)," which features an evolving communication between physicians and patients/families with ongoing incorporation of the patient's/family's perspective. This process continues iteratively until each decision can be reached in a way that is both harmonious with the patient's/family's perspective and is consistent with medical treatment options that are actionable for the healthcare team. We include a table of tools drawn from the literature that can help clinicians when implementing AdaptCP.