Cavalieri Thomas A, Latif Walead, Ciesielski Janice, Ciervo Carman A, Forman Lloyd J
University of Medicine and Dentistry of New Jersey-School of Ostoepathic Medicine, Stratford 08084-1504, USA.
J Am Osteopath Assoc. 2002 Oct;102(10):541-4.
Decision-making ability regarding end-of-life issues is often compromised by dementia in patients with Alzheimer's disease. This study assessed physicians' discussions of advance care planning with patients with mild to moderate Alzheimer's disease. Data were collected by a survey of full-time faculty in the departments of Medicine and Family Medicine and the Center for Aging at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, as well as physicians in private practice affiliated with the Kennedy Health System. Data consisted of questions that assessed whether advance care planning was provided, what specific topics were discussed, and what actions were taken if advance care planning was not offered. Of the 271 physicians to whom the survey was sent, 63 responded, for a return rate of 23%. Of those responding, 81% indicated that they counseled their patients regarding advance care planning issues, while 19% did not. Of those who provided advance care planning for their patients (N = 51), 88% discussed living wills; 53%, the durable power of attorney for healthcare; 47%, end-of-life care; and 35%, financial planning issues. Thirty-seven percent recommended an elder law attorney, and 31% made a referral to the Alzheimer's Association. Of those who provided advance care planning for their patients' caregivers (N = 51), 86% discussed living wills; 78%, nursing home care; 69%, driving issues; and 47%, end-of-life care. Twenty-five percent referred their patients to an elder law attorney. Results indicate that physicians need to be more knowledgeable and proactive in their approaches to advance care planning for patients with mild to moderate Alzheimer's disease.
阿尔茨海默病患者的痴呆症常常会损害其在临终问题上的决策能力。本研究评估了医生与轻度至中度阿尔茨海默病患者关于预先护理计划的讨论情况。数据通过对新泽西医学院-骨科医学院医学系、家庭医学系和衰老中心的全职教员，以及与肯尼迪医疗系统相关的私人执业医生进行调查收集。数据包括评估是否提供了预先护理计划、讨论了哪些具体主题以及如果未提供预先护理计划采取了哪些行动的问题。在发送调查问卷的271名医生中，63人回复，回复率为23%。在回复者中，81%表示他们就预先护理计划问题向患者提供了咨询，而19%没有。在为患者提供预先护理计划的医生中（N = 51），88%讨论了生前遗嘱；53%讨论了医疗保健的持久委托书；47%讨论了临终护理；35%讨论了财务规划问题。37%推荐了老年法律律师，31%将患者转介至阿尔茨海默病协会。在为患者的护理人员提供预先护理计划的医生中（N = 51），86%讨论了生前遗嘱；78%讨论了养老院护理；69%讨论了驾驶问题；47%讨论了临终护理。25%将患者转介给老年法律律师。结果表明，医生在为轻度至中度阿尔茨海默病患者进行预先护理计划时，需要在方法上更有见识且更积极主动。
