Study On The Construction Of Intervention Model Of ACP For Elderly Patients With Chronic Diseases In Community

ObjectiveTo construct the ACP intervention program for the elderly chronic disease patients in the community of China,and researched elderly chronic disease patients who lived in Tianjin community,to verify the application effect of community-based elderly chronic disease patients’ ACP intervention program,and provide clinical practice theory and basis for larger-scale ACP intervention program.Methods1.Literature research: Search databases,understand the elderly in chronic diseases the attitude of ACP in different counties,evaluate the current domestic and foreign ACP intervention mode,and provide practice theory and practice for the construction of community ACP intervention program for elderly patients with chronic diseases.2.Qualitative research: 30 elderly patients with chronic diseases in the community were interviewed in a semi-structured way,and the data were analyzed with the method of Colaizzi analysis,to provide practical basis for the establishment of ACP intervention program for elderly patients with chronic diseases.3.Group discussion: through brainstorming and group discussion,ACP intervention program for elderly chronic disease patients in community are preliminarily determined to form the first draft of the intervention program.4.Expert consultation: Through consultation with 13 experts with theoretical and practical experience in geriatric nursing,geriatric medicine and hospice care,modify the ACP intervention scheme for elderly chronic disease patients in the community according to the expert’s suggestions.5.Pre experiment: 30 elderly patients with chronic diseases were randomly selected from the community to carry out ACP study,and the intervention scheme was modified according to the results.6.Application of ACP intervention program for elderly chronic disease patients in community: By convenient sampling method,243 elderly chronic disease patientsin 10 communities of Tanggu Street Community in Binhaixinqu of Tianjin were selected according to the inclusion criteria,and randomly divided into intervention group and control group according to the method of random draw to compare,and verify the feasibility of the intervention program,including 123 cases in intervention group and 120 cases in control group Example.The control group implemented the routine management of community hospital,and the intervention group increased the ACP intervention program for the elderly patients with chronic diseases on the basis of routine management.7.Before intervention and one month later,the knowledge level and acceptance degree and death anxiety level of the elderly patients with chronic diseases in the community were assessed by questionnaire..Results1.Construction of intervention plan(1)Expert consultation: the first round of Delphi method was used to distribute15 questionnaires,called back 13 questionnaires available,with a recovery rate of87%.In the second round,13 questionnaires were sent out and called back 13 questionnaires available,with a recovery rate of 100%.The authority coefficient of expert group is 0.935.The results of the first round of Delphi expert consultation show that the variation coefficient of a secondary index is greater than 0.25,the mean is less than 3.5,and the variation coefficient of a tertiary index is greater than 0.25,the mean is less than 3.5.The coefficient of variation of other indexes was 0.00-0.14,and the mean was more than 0.35.The second round of Delphi expert consultation results show that the coefficient of variation of all levels of indicators are less than0.25,and the mean is greater than 3.5.(2)Construction of ACP intervention program for elderly chronic disease patients in the community: the first round of Delphi expert consultation,delete 2indicators,increase 8 indicators.The second round of Delphi expert consultation did not change.ACP intervention program for elderly chronic disease patients in community includes 5 first level indicators,14 second level indicators and 12 third level indicators.2.Validation study of intervention plan(1)Knowledge level of patients with ads: before the intervention,there was no significant difference between the two groups(P > 0.05).After the intervention,the scores of ads knowledge between the two groups were statistically significant(P <0.05).There was no significant difference in the scores of ads knowledge before and after intervention in the control group(P > 0.05).There was significant difference in the scores of ads knowledge before and after the intervention in the intervention group(P < 0.05).(2)Patients’ acceptance of ads: before the intervention,there was no significant difference between the two groups(P > 0.05).There was a significant difference in the acceptance of ads between the two groups(P < 0.05).There was no significant difference in the acceptance of ads before and after intervention in the control group(P > 0.05).The acceptance of ads in the intervention group was statistically significant(P < 0.05).(3)There was no significant difference between the two groups before intervention(P > 0.05).The difference of death anxiety scores between the two groups was statistically significant(P < 0.05).There was no significant difference in the scores of death anxiety before and after intervention in the control group(P >0.05).The difference of death anxiety score before and after intervention in the intervention group was statistically significant(P < 0.05).ConclusionsThe ACP intervention program for the elderly chronic disease patients in the community has a high applicability,which can effectively improve the knowledge level,the acceptance of ads and reduce the death anxiety of the elderly chronic disease patients in the community.