Freer Jack P, Eubanks Michael, Parker Brandon, Hershey Charles O
Division of General Internal Medicine, University at Buffalo, State University of New York, USA.
Am J Med. 2006 Dec;119(12):1088.e9-13. doi: 10.1016/j.amjmed.2006.02.028.
There is a growing awareness of the need for discussion of advance directives (ADs) in the ambulatory setting, but rates of completion remain low. Clarification of patients' perceptions and knowledge would help in designing future strategies.
This is a prospective study of adult ambulatory patients at four academic internal medicine clinical sites at the University at Buffalo during a 6-week period in 2004. We obtained data using a standard instrument administered by a research assistant. The data included demographic variables, patients' awareness of and familiarity with specific ADs, and whether the patient had any ADs. Patients also were asked about attitudes concerning the appropriateness of ADs. We performed multivariate logistic regression on the variables.
Of 508 patients, 86.2% were unfamiliar with the term "advance directives," but 93.5% were familiar with one or more specific kinds of ADs. Some 43.1% of patients claimed to have completed an AD, but of those who said they had, only 25% thought their provider had a copy. Multivariate logistic regression demonstrated significant correlation between having completed an AD and age, reading ability, and educational level (all P < .001).
A large number of patients in an ambulatory internal medicine practice knew about ADs and believed they had completed such documents, but these documents were often not in the chart. Many patients believe discussions of ADs are not appropriate for them. A better understanding of this phenomenon will help in promoting effective advance care planning.
在门诊环境中，人们越来越意识到需要讨论预立医疗指示（ADs），但完成率仍然很低。澄清患者的认知和知识将有助于设计未来的策略。
这是一项对2004年为期6周的布法罗大学四个学术内科临床站点的成年门诊患者进行的前瞻性研究。我们使用由研究助理管理的标准工具获取数据。数据包括人口统计学变量、患者对特定预立医疗指示的认知和熟悉程度，以及患者是否有任何预立医疗指示。患者还被问及对预立医疗指示适当性的态度。我们对这些变量进行了多变量逻辑回归分析。
在508名患者中，86.2%不熟悉“预立医疗指示”一词，但93.5%熟悉一种或多种特定类型的预立医疗指示。约43.1%的患者声称已完成预立医疗指示，但在那些表示已完成的患者中，只有25%认为他们的医疗服务提供者有副本。多变量逻辑回归分析表明，完成预立医疗指示与年龄、阅读能力和教育水平之间存在显著相关性（所有P < .001）。
大量门诊内科患者了解预立医疗指示并认为他们已完成此类文件，但这些文件往往不在病历中。许多患者认为讨论预立医疗指示对他们不合适。更好地理解这一现象将有助于促进有效的临终关怀规划。
