Taylor D McD, Ugoni A M, Cameron P A, McNeil J J
Department of Emergency Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
Intern Med J. 2003 Dec;33(12):586-92. doi: 10.1111/j.1445-5994.2003.00423.x.
Advance directives (ADs) are rarely available in Australia to guide management but may become more important as our population ages.
The present study aimed to determine patient knowledge, perception and ownership rates of ADs and the factors that impact upon these variables.
A cross-sectional survey of emergency department patients was undertaken. The main outcome measures were: (i) prior discussion about the extent of medical treatment and ADs, (ii) knowledge and perceptions of ADs, (iii) present AD ownership rates and (iv) likelihood of future AD ownership. Generalized linear models were used for analysis.
Four hundred and three patients were enrolled. The mean age of patients was 73 years and 239 (59.3%) were male. Two hundred and forty patients (59.6%) had discussed the extent of treatment. Only 81 patients (20.1%) had discussed the use of an AD. One hundred and thirty-seven patients (34.0%) knew of one type of AD and 333 patients (82.6%) thought some ADs were a good idea. Only 32 patients (7.9%) owned an AD, although 276 (68.5%) would consider owning one. The main reason for never obtaining an AD was "always wanting full treatment" (93 patients, 23.1%). Level of education was the only characteristic that impacted significantly upon an outcome measure. Patients with a higher level of education were more likely to have known and spoken about ADs, to own an AD and to consider owning one.
AD knowledge and ownership rates were low. However, most patients perceive them favourably and many would consider owning one. Intervention strategies to improve AD awareness are indicated. This may empower patients to more effectively participate in their own advance care planning.
在澳大利亚，预先指示很少能用于指导医疗管理，但随着我国人口老龄化，其可能会变得更加重要。
本研究旨在确定患者对预先指示的知晓情况、认知和持有率，以及影响这些变量的因素。
对急诊科患者进行了一项横断面调查。主要结局指标为：（i）之前关于医疗治疗程度和预先指示的讨论；（ii）对预先指示的知晓和认知；（iii）当前预先指示持有率；（iv）未来持有预先指示的可能性。采用广义线性模型进行分析。
共纳入403例患者。患者的平均年龄为73岁，男性239例（59.3%）。240例患者（59.6%）讨论过治疗程度。仅81例患者（20.1%）讨论过预先指示的使用。137例患者（34.0%）知晓一种预先指示类型，333例患者（82.6%）认为一些预先指示是个好主意。仅有32例患者（7.9%）持有预先指示，尽管276例患者（68.5%）会考虑持有。从未获得预先指示的主要原因是“一直希望接受全面治疗”（93例患者，23.1%）。教育程度是唯一对结局指标有显著影响的特征。教育程度较高的患者更有可能知晓并谈论过预先指示、持有预先指示以及考虑持有预先指示。
预先指示的知晓率和持有率较低。然而，大多数患者对其看法良好，许多患者会考虑持有。表明需要采取干预策略来提高对预先指示的认识。这可能使患者能够更有效地参与自身的预先护理计划。
