Dimond E P
Cancer Nursing Service, National Institutes of Health, Bethesda, MD.
Oncol Nurs Forum. 1992 Jul;19(6):891-6.
In December 1991, Patient Self-Determination Amendment (PSDA) legislation was implemented. The PSDA requires facilities funded by Medicare/Medicaid to inform patients of their decision-making rights regarding medical care. An advance directive (AD), a living will, or a durable power of attorney for health care contains statements made by competent people directing their medical care if they should become incompetent. Oncology nurses are in an advantageous position to educate and advocate for their patients with respect to end-of-life decisions. They are qualified to facilitate the AD process by virtue of their ability to relate to patients and families their extensive experience with the terminally ill and their expertise as liasons between patients, families, and the multidisciplinary team. A clear understanding of the patient's wishes regarding life-sustaining treatments enables the oncology nurse to advocate more effectively on the patient's behalf. This article highlights definitions of ADs, advantages and disadvantages of each, and recommendations for the oncology nurse's practice.
1991年12月，《患者自主决定修正案》（PSDA）立法开始实施。PSDA要求由医疗保险/医疗补助计划资助的机构告知患者他们在医疗护理方面的决策权。预先医疗指示（AD）、生前遗嘱或医疗保健持久授权书包含有行为能力的人做出的声明，指示如果他们丧失行为能力，应如何接受医疗护理。肿瘤学护士在就临终决策对患者进行教育和提供支持方面具有优势地位。凭借其与患者及其家属建立联系的能力、在绝症患者方面的丰富经验以及作为患者、家属和多学科团队之间联络人的专业知识，他们有资格推动预先医疗指示流程。清楚了解患者对维持生命治疗的意愿，能使肿瘤学护士更有效地代表患者进行支持。本文重点介绍了预先医疗指示的定义、每种指示的优缺点以及对肿瘤学护士实践的建议。
