一项关于心肺复苏和预立医疗指示的多媒体干预措施。
A multimedia intervention on cardiopulmonary resuscitation and advance directives.
作者信息
Yamada R, Galecki A T, Goold S D, Hogikyan R V
机构信息
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Gen Intern Med. 1999 Sep;14(9):559-63. doi: 10.1046/j.1525-1497.1999.11208.x.
OBJECTIVE
To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans.
DESIGN
Prospective randomized controlled, single blind study of educational interventions.
SETTING
General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC).
PARTICIPANTS
One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions.
INTERVENTION
The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs.
MEASUREMENTS AND MAIN RESULTS
Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p <.001) and this effect, although diminished, persisted in the follow-up questionnaire (OR = 3.92, p =. 003). Prior to any intervention, 15% of subjects correctly estimated the likelihood of survival after CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS).
CONCLUSION
We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.
目的
评估一项关于预立医疗指示（ADs）和心肺复苏（CPR）的多媒体教育干预措施对老年退伍军人关于ADs及维持生命治疗的知识、态度和行为的影响。
设计
教育干预的前瞻性随机对照单盲研究。
地点
一所大学附属退伍军人事务医疗中心（VAMC）的普通内科诊所。
参与者
117名70岁及以上、被认为有能力做出医疗护理决策的退伍军人。
干预措施
对照组（n = 55）收到一份VAMC正在使用的关于ADs的资料。实验组（n = 62）收到相同的资料，外加一份描述CPR程序方面和结果的资料，并观看了一段关于ADs的录像带。
测量指标及主要结果
通过自行填写问卷，在干预前、干预后以及干预后2至4周记录患者对ADs、CPR和维持生命治疗的态度及行为。干预前问卷中，只有27.8%的受试者表示知道什么是ADs。实验组和对照组（实验组87.2%，对照组52.5%）这一比例均有所提高，但实验组对ADs的知晓情况更高（优势比 = 6.18，p <.001），且这一效果虽有所减弱，但在随访问卷中仍然存在（OR = 3.92，p =.003）。在任何干预之前，15%的受试者正确估计了CPR后的存活可能性。干预后实验组这一情况有所改善（OR = 4.27，p =.004），但随访时未持续。在干预后问卷中，两组中很少有受试者表示当天与医生讨论过CPR或ADs（OR = 0.97，p = 无显著差异）。
结论
我们开发了一种方便的方法来教育老年男性患者关于CPR和预立医疗指示，该方法改善了短期知识，但未促进预先护理计划。
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