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1.文献信息：
Title:Experiences and perspectives on the optimal timing for initiating advance care planning in patients with mild to moderate dementia: A meta-synthesis.
轻中度痴呆患者启动预立医疗照护计划的最佳时机的经验和观点:一项Meta整合。
Journal:International Journal of Nursing Studies .
IF//JCR分区: 7.5/Q1.
Keyword:Dementia ; Advance care planning ; Optimal timing ; Systematic review.
痴呆；预立医疗照护计划；最佳时机；系统综述。
Design:A meta-synthesis.
一项Meta整合。
2. 摘要 Abstract：
（译文仅供参考）
Background: Advance care planning is typically initiated during the last six months of a patient's life. However, due to the progressive decline in the decision-making process in individuals with dementia, their involvement in advance care planning is limited to the early stages of the disease. Currently, there is no consensus on the optimal timing for initiating advance care planning for people with dementia, and a comprehensive review of the literature addressing this matter is lacking.
背景:预立医疗照护计划通常是在病人生命的最后六个月开始的。然而，由于痴呆症患者的决策过程逐渐下降，他们对预立医疗照护计划的参与仅限于疾病的早期阶段。目前，对于启动痴呆症患者的预立医疗照护计划的最佳时机没有达成共识，并且缺乏对这一问题的文献的全面回顾。
Objective: To explore the experiences and perspectives of people with dementia, their family caregivers, and health care professionals with regard to the optimal timing for initiating advance care planning.
目的:探讨痴呆症患者、其家庭照顾者和卫生保健专业人员在启动预立医疗照护计划的最佳时机方面的经验和观点。
Review methods: This review uses thematic synthesis to systematically synthesize qualitative evidence and report findings according to The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and the Joanna Briggs Institute Manual for Evidence Synthesis. Study selection and data extraction were conducted independently by two researchers, and quality was evaluated using the Joanna Briggs Institute's Qualitative Research Standard Assessment tool.
综述方法:根据《提高定性研究综合报告的透明度》(ENTREQ)和《乔安娜布里格斯研究所证据综合手册》，采用专题综合方法系统地综合定性证据并报告研究结果。研究选择和数据提取由两名研究人员独立进行，质量评估使用乔安娜布里格斯研究所的定性研究标准评估工具。
Findings: Twenty-one studies were selected for this review. This review involved an overarching theme: The utilization of pivotal elements to transition from delayed initiation to comprehensive implementation. Three themes emerge, including the prerequisites for initiating advance care planning, not ready to start advance care planning and struggling along narrow roads. For health care professionals, the selection of an opportune moment to initiate advance care planning for people with dementia is not only a challenge but also a crucial prerequisite for the successful implementation of advance care planning. Health care professionals' experience, attitude toward advance care planning, trust relationship with patients, cultural differences among people with dementia and their caregivers, and economic disparities all influence health care professionals' judgment of the timing for initiating advance care planning.
结果:本综述选取了21项研究。这次审查涉及一个总体主题:利用关键要素从延迟启动过渡到全面实施。出现了三个主题，包括启动预立医疗照护计划的先决条件，未准备好开始预立医疗照护计划以及在狭窄的道路上挣扎。对于卫生保健专业人员来说，选择一个合适的时机为痴呆症患者启动预立医疗照护计划不仅是一项挑战，也是成功实施预立医疗照护计划的关键先决条件。卫生保健专业人员的经验、对预立医疗照护计划的态度、与患者的信任关系、痴呆症患者及其照顾者之间的文化差异以及经济差异都会影响卫生保健专业人员对启动预立医疗照护计划时机的判断。
Conclusions: Determining the optimal timing for initiating advance care planning is a complex process that requires a comprehensive consideration of the realities faced by health care professionals, people with dementia and their caregivers. Therefore, it is imperative to provide relevant training to health care professionals to ensure the successful implementation of advance care planning.
结论:确定启动预立医疗照护计划的最佳时机是一个复杂的过程，需要全面考虑卫生保健专业人员、痴呆症患者及其护理人员面临的现实。因此，为确保预立医疗照护计划的成功实施，对医护人员进行相关培训势在必行。
3.文献新知扩展：
①预立医疗照护计划是什么
原文原句：The recent international consensus statement published by the European Association of Palliative Care has defined advance care planning as follows: a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.
欧洲姑息治疗协会最近发表的国际共识声明将预立医疗照护计划定义如下:一个支持处于任何年龄或健康阶段的成年人了解和分享他们的个人价值观、生活目标和对未来医疗护理的偏好的过程。
预立医疗照护计划（Advance Care Planning，简称ACP）是指患者在意识清醒时，基于对自己病情预后和临终治疗措施的理解，结合个人的生活经验和价值观，预先表明在将来进入临终状态时的治疗护理意愿。这个过程包括与医务人员和/或亲属沟通这些意愿，以便在患者无法自行做出医疗决策时，他人能够根据患者的预先指示来进行医疗照护。ACP的目的是尊重患者的医疗自主权，改善患者终末期的生命质量，减少不必要的医疗干预，减轻家属的经济和心理负担。
ACP特别适用于危重症和生命终末期患者，因为这些患者的病情复杂多变，预后不明确，且可能面临生命危险。通过ACP，可以确保患者的意愿得到尊重，避免在生命的最后阶段出现过度医疗或不符合患者意愿的治疗。此外，ACP有助于促进医患之间的沟通，增进家属对患者意愿的理解和支持。
虽然ACP不是具有法律强制力的文件，但它是患者意愿的书面表达，可以作为医疗决策的重要参考。在某些国家和地区，ACP可能具有一定的法律地位，医生和医疗机构在尊重患者意愿的前提下，通常会尽力遵循ACP中的指示。然而，医生或机构也可能出于道德或宗教原因拒绝执行ACP中的某些指令，因此在制定ACP时，与医疗提供者的充分沟通至关重要。
ACP的实施通常包括以下几个步骤：
②ACP的实施步骤：CERQual是什么
原文原句：The quality scores of the studies ranged from 7 to 9. Most studies (n = 17) failed to describe the influence of the researchers on the research (Table 3). CERQual was used to evaluate the level of confidence in the findings of each review. Two topics were rated as high confidence, and four topics were rated as medium confidence (Supplementary File 2).
CERQual（Confidence in the Evidence from Reviews of Qualitative research）是一个用于评估定性研究合成证据可信度的框架。它旨在帮助指南制定者和决策者理解从定性研究中得出的发现的可靠性，并据此做出更加明智的决策。CERQual考虑了四个主要组成部分：方法论限制、相关性、一致性和数据的充分性。这些组成部分共同决定了对特定综述发现的信心水平。此外，还有第五个潜在的组成部分，即传播偏差，正在被进一步研究以确定其对定性证据综合的影响。
③批判性评价图
原文原图：
Q1.所陈述的哲学观点与研究方法之间是否存在一致性？
Q2.研究方法与研究问题或目标之间是否存在一致性？
Q3.在研究方法和用于收集数据的方法之间是否有一致性？
Q4.研究方法与数据的表示和分析之间是否存在一致性？
Q5.研究方法和对结果的解释之间是否存在一致性？
Q6.是否有文化或理论上的陈述？
Q7.研究人员对研究的影响，反之亦然？
Q8.参与者和他们的声音是否得到了充分的代表？
Q9.该研究是否符合当前的标准的伦理，还是根据最近的研究，是否有证据表明有适当机构的伦理批准？
Q10.研究报告中得出的结论是否来自于对数据的分析或解释？
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