Wilder Christine M, Elbogen Eric B, Swartz Marvin S, Swanson Jeffrey W, Van Dorn Richard A
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3837, Durham, NC 27710, USA.
Psychiatr Serv. 2007 Oct;58(10):1348-50. doi: 10.1176/ps.2007.58.10.1348.
Clinicians have raised concerns that psychiatric advance directives may be used to refuse all treatment. However, people writing psychiatric advance directives can explicitly state their reasoning underlying treatment decisions. This study examined whether patients' reasons for refusing treatment influenced clinician decision making about implementing psychiatric advance directives.
A total of 597 mental health professionals completed a questionnaire that presented two scenarios: one in which the patient wrote a psychiatric advance directive refusing all medication because of paranoid delusions and one in which the patient wrote a psychiatric advance directive refusing all medication because of concerns about side effects.
Twenty-two percent of clinicians reported that they would respect the former psychiatric advance directive, whereas 72% reported that they would respect the latter. After multivariate regression was used, the reason for treatment refusal remained the single significant predictor of clinicians' decision to honor a patient's psychiatric advance directive.
Results show reasons for treatment refusal in psychiatric advance directives are likely to affect clinicians' decisions to implement the directives.
临床医生担心精神科预先指示可能会被用于拒绝所有治疗。然而，撰写精神科预先指示的人可以明确说明其治疗决策背后的理由。本研究调查了患者拒绝治疗的理由是否会影响临床医生关于执行精神科预先指示的决策。
共有597名心理健康专业人员完成了一份问卷，其中呈现了两种情景：一种情景是患者因偏执妄想而撰写精神科预先指示拒绝所有药物治疗，另一种情景是患者因担心副作用而撰写精神科预先指示拒绝所有药物治疗。
22%的临床医生报告称他们会尊重前一种精神科预先指示，而72%的临床医生报告称他们会尊重后一种。在使用多元回归分析后，拒绝治疗的理由仍然是临床医生决定尊重患者精神科预先指示的唯一显著预测因素。
结果表明，精神科预先指示中拒绝治疗的理由可能会影响临床医生执行这些指示的决策。
