Foti Mary Ellen, Bartels Stephen J, Merriman Melanie P, Fletcher Kenneth E, Van Citters Aricca D
University of Massachusetts Medical School, Worcester, MA, USA.
Psychiatr Serv. 2005 May;56(5):576-84. doi: 10.1176/appi.ps.56.5.576.
This study examined preferences regarding medical advance care planning among persons with serious mental illness, specifically, experience, beliefs, values, and concerns about health care proxies and end-of-life issues.
A structured interview, the Health Care Preferences Questionnaire, was administered to a convenience sample of 150 adults with serious mental illness who were receiving community-based services from the Massachusetts Department of Mental Health. Clinical information and demographic data were also collected.
A total of 142 participants completed the questionnaire. Although more than one-quarter had thought about their medical treatment preferences in the event that they became seriously medically ill, very few had discussed these preferences. A majority of respondents (72 percent) believed that someone should be designated to make medical health care decisions for a person who is too sick to make or communicate these decisions him- or herself. Common end-of-life concerns included financial and emotional burdens on family, pain and suffering, interpersonal issues such as saying "goodbye," spiritual issues, and funeral arrangements. Participants were most uneasy about the prolonging or stopping of life support by proxy decision makers. A total of 104 respondents (69 percent) expressed interest in formally selecting a health care proxy.
Although persons with serious and persistent mental illness have little experience with medical advance care planning, they show substantial interest in it. Furthermore, they are able to consider and communicate their preferences. This study supports the feasibility, acceptability, and utility of a standardized approach to medical advance care planning with this population.
本研究调查了严重精神疾病患者对医疗预立照护计划的偏好，具体包括他们在医疗代理和临终问题方面的经历、信念、价值观及担忧。
采用结构化访谈——《医疗照护偏好问卷》，对150名接受马萨诸塞州精神卫生部社区服务的成年严重精神疾病患者进行了便利抽样调查。同时收集了临床信息和人口统计学数据。
共有142名参与者完成了问卷。尽管超过四分之一的人曾考虑过在身患重病时自己的医疗治疗偏好，但很少有人讨论过这些偏好。大多数受访者（72%）认为，对于病重到无法自行做出或传达医疗决策的人，应该指定他人为其做出医疗保健决策。常见的临终担忧包括给家人带来的经济和情感负担、疼痛和痛苦、诸如说“再见”之类的人际问题、精神问题以及葬礼安排。参与者对代理决策者延长或停止生命支持最为不安。共有104名受访者（69%）表示有兴趣正式选择一名医疗代理人。
尽管严重持续性精神疾病患者在医疗预立照护计划方面经验甚少，但他们对此表现出浓厚兴趣。此外，他们能够思考并表达自己的偏好。本研究支持对这一人群采用标准化医疗预立照护计划方法的可行性、可接受性和实用性。
