为适应大多数成年人文化水平而重新设计的预先医疗指示：一项随机试验。
An advance directive redesigned to meet the literacy level of most adults: a randomized trial.
作者信息
Sudore Rebecca L, Landefeld C Seth, Barnes Deborah E, Lindquist Karla, Williams Brie A, Brody Robert, Schillinger Dean
机构信息
Division of Geriatrics, University of California San Francisco and the San Francisco Veterans Affairs Medical Center, CA 94121, USA, United States.
出版信息
Patient Educ Couns. 2007 Dec;69(1-3):165-95. doi: 10.1016/j.pec.2007.08.015. Epub 2007 Oct 17.
OBJECTIVE
To determine whether an advance directive redesigned to meet most adults' literacy needs (fifth grade reading level with graphics) was more useful for advance care planning than a standard form (>12th grade level).
METHODS
We enrolled 205 English and Spanish-speaking patients, aged >/=50 years from an urban, general medicine clinic. We randomized participants to review either form. Main outcomes included acceptability and usefulness in advance care planning. Participants then reviewed the alternate form; we assessed form preference and six-month completion rates.
RESULTS
Forty percent of enrolled participants had limited literacy. Compared to the standard form, the redesigned form was rated higher for acceptability and usefulness in care planning, P</=0.03, particularly for limited literacy participants (P for interaction </=0.07). The redesigned form was preferred by 73% of participants. More participants randomized to the redesigned form completed an advance directive at six months (19% vs. 8%, P=0.03); of these, 95% completed the redesigned form.
CONCLUSIONS
The redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates.
PRACTICE IMPLICATIONS
An advance directive redesigned to meet most adults' literacy needs may better enable patients to engage in advance care planning.
目的
确定重新设计以满足大多数成年人识字需求（五年级阅读水平并配有图表）的预先指示，相较于标准表格（十二年级以上阅读水平），在预先护理计划方面是否更有用。
方法
我们招募了205名年龄≥50岁、来自城市综合内科诊所且说英语和西班牙语的患者。我们将参与者随机分组，让他们分别查看两种表格中的一种。主要结果包括预先护理计划中的可接受性和有用性。然后，参与者查看另一种表格；我们评估了表格偏好和六个月内的填写完成率。
结果
40%的登记参与者识字能力有限。与标准表格相比，重新设计的表格在护理计划的可接受性和有用性方面评分更高，P≤0.03，尤其是对于识字能力有限的参与者（交互作用P≤0.07）。73%的参与者更喜欢重新设计的表格。随机分组到重新设计表格的参与者在六个月内完成预先指示的比例更高（19%对8%，P=0.03）；在这些完成的参与者中，95%完成的是重新设计的表格。
结论
重新设计的预先指示在预先护理计划方面被评为更可接受和有用，且比标准表格更受青睐。它还导致六个月内的填写完成率更高。
实践意义
重新设计以满足大多数成年人识字需求的预先指示，可能会更好地使患者参与预先护理计划。
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