Hughes D L, Singer P A
Wellesley Hospital, University of Toronto, Ont.
CMAJ. 1992 Jun 1;146(11):1937-44.
To examine the attitudes toward, the experience with and the knowledge of advance directives of family physicians in Ontario.
Cross-sectional survey.
A questionnaire was mailed to 1000 family physicians, representing a random sample of one-third of the active members of the Ontario College of Family Physicians; 643 (64%) responded.
In all, 86% of the physicians favoured the use of advance directives, but only 19% had ever discussed them with more than 10 patients. Most of the physicians agreed with statements supporting the use of advance directives and disagreed with statements opposing their use. Of the respondents 80% reported that they had never used a directive in managing an incompetent patient. Of the physicians who responded that they had such experience, over half said that they had not always followed the directions contained in the directive. The proportions of physicians who responded that certain patient groups should be offered the opportunity to complete an advance directive were 96% for terminally ill patients, 95% for chronically ill patients, 85% for people with human immunodeficiency virus infection, 77% for people over 65 years of age, 43% for all adults, 40% for people admitted to hospital on an elective basis and 33% for people admitted on an emergency basis. The proportions of physicians who felt that the following strategies would encourage them to offer advance directives to their patients were 92% for public education, 90% for professional education, 89% for legislation protecting physicians against liability when following a directive, 80% for legislation supporting the use of directives, 79% for hospital policy supporting the use of directives, 73% for reimbursement for time spent discussing directives with patients and 64% for hospital policy requiring that all patients be routinely offered the opportunity to complete a directive at the time of admission.
Family physicians favour advance directives but use them infrequently. Most physicians support offering them to terminally or chronically ill patients but not to all patients at the time of admission to hospital. Although governments emphasize legislation, most physicians believe that public and professional education programs would be at least as likely as legislation to encourage them to offer advance directives to their patients.
调查安大略省家庭医生对预立医疗指示的态度、经验及了解程度。
横断面调查。
向1000名家庭医生邮寄了问卷，这些医生是安大略省家庭医生学院三分之一在职成员的随机样本；643人（64%）回复。
总体而言，86%的医生赞成使用预立医疗指示，但只有19%的医生曾与超过10名患者讨论过该指示。大多数医生同意支持使用预立医疗指示的陈述，不同意反对使用的陈述。80%的受访者表示他们在处理无行为能力患者时从未使用过指示。在有此类经验的医生中，超过一半表示他们并非总是遵循指示中的说明。对于某些患者群体应被给予机会完成预立医疗指示，认为应该给予绝症患者的医生比例为96%，慢性病患者为95%，感染人类免疫缺陷病毒者为85%，65岁以上人群为77%，所有成年人中为43%，择期入院患者为40%，急诊入院患者为33%。认为以下策略会促使他们向患者提供预立医疗指示的医生比例分别为：公众教育92%，专业教育90%，保护医生遵循指示时免于承担责任的立法89%，支持使用指示的立法80%，支持使用指示的医院政策79%，报销与患者讨论指示所花费时间73%，以及要求所有患者在入院时常规获得完成指示机会的医院政策64%。
家庭医生赞成预立医疗指示，但很少使用。大多数医生支持向绝症或慢性病患者提供，但不支持在患者入院时向所有患者提供。尽管政府强调立法，但大多数医生认为公众和专业教育项目至少与立法一样有可能促使他们向患者提供预立医疗指示。
