Buchanan Robert J, Bolin Jane, Wang Suojin, Zhu Li, Kim MyungSuk
College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223-0001, USA.
J Rural Health. 2004 Spring;20(2):131-5. doi: 10.1111/j.1748-0361.2004.tb00019.x.
Advance directives promote patient autonomy and encourage greater awareness of final care options while reducing physician and family uncertainty regarding patient preferences.
To investigate differences in decision making authority and the use of advance directives among nursing home residents admitted from urban and rural areas.
A total of 551,208 admission assessments in the Minimum Data Set were analyzed for all residents admitted to a nursing facility in 2001. Using the Rural Urban Commuting Areas (RUCA) methodology and ZIP code of primary residence before admission, these residents were classified into 4 urban/rural areas.
Residents from rural areas were significantly more likely to have executed a durable power of attorney for health care or for financial decisions than residents admitted from the other areas, with the largest differences observed between residents admitted from urban and rural areas. Almost 6 residents in 10 from urban areas had no advance directives in place at admission compared with only 4 residents in 10 admitted from rural areas.
Health providers and social workers in both rural and urban areas should advise patients about the value of advance directives.
预立医疗指示促进患者自主权，鼓励患者更多地了解临终护理选择，同时减少医生和家属对患者偏好的不确定性。
调查城乡地区入住养老院居民在决策权力和预立医疗指示使用方面的差异。
对2001年入住护理机构的所有居民在最低数据集里的551208份入院评估进行分析。利用城乡通勤区（RUCA）方法以及入院前主要居住地的邮政编码，将这些居民分为4个城乡区域。
与其他地区入住的居民相比，农村地区的居民更有可能已签署医疗保健或财务决策的持久授权书，城乡地区入住居民之间的差异最为明显。城市地区每10名入院居民中近6人在入院时没有预立医疗指示，而农村地区每10名入院居民中只有4人没有。
城乡地区的医疗服务提供者和社会工作者都应向患者告知预立医疗指示的价值。
