Aitken P V
State University of New York Health Sciences Center, Stony Brook, USA.
Am Fam Physician. 1999 Feb 1;59(3):605-14, 617-20.
Despite widespread support for the concept of advance care planning, few Americans have a living will or a health care proxy. Advance care planning offers the patient the opportunity to have an ongoing dialog with his or her relatives and family physician regarding choices for care at the end of life. Ultimately, advance care planning is designed to clarify the patient's questions, fears and values, and thus improve the patient's well-being by reducing the frequency and magnitude of overtreatment and undertreatment as defined by the patient. An advance directive consists of oral and written instructions about a person's future medical care in the event he or she becomes unable to communicate. There are two types of advance directives: a living will and a health care power of attorney. Family physicians are in an ideal position to discuss advance care plans with their patients. By introducing the subject during a routine office visit, physicians can facilitate a structured discussion of the patient's wishes for end-of-life care. At the next visit, further discussion can include the patient and his or her proxy. A document that clearly delineates the patient's wishes is then developed. The patient should be assured that the directive can be changed at any time according to the patient's wishes. The advance care plan should be reviewed periodically to make sure the specifications continue to be in line with the patient's wishes.
尽管对预先护理计划的概念普遍支持，但很少有美国人拥有生前遗嘱或医疗保健代理人。预先护理计划为患者提供了一个机会，使其能够与亲属和家庭医生就临终护理的选择进行持续对话。最终，预先护理计划旨在澄清患者的问题、恐惧和价值观，从而通过减少患者所定义的过度治疗和治疗不足的频率和程度来改善患者的福祉。预先指示包括关于一个人在无法交流时未来医疗护理的口头和书面指示。预先指示有两种类型：生前遗嘱和医疗保健委托书。家庭医生处于与患者讨论预先护理计划的理想位置。通过在常规门诊就诊时引入这个话题，医生可以促进对患者临终护理愿望的结构化讨论。在下一次就诊时，进一步的讨论可以包括患者及其代理人。然后制定一份清楚描述患者愿望的文件。应向患者保证，该指示可根据患者的意愿随时更改。预先护理计划应定期审查，以确保其规定继续符合患者的意愿。
