Veterans Affairs Medical Center, Department of Medicine, University of California, San Francisco, San Francisco, California 94121, USA.
J Health Commun. 2010;15 Suppl 2(Suppl 2):159-71. doi: 10.1080/10810730.2010.499982.
The complexities associated with advance treatment decisions may result in decisional uncertainty and poorly informed choices, particularly among vulnerable populations such as minorities and patients with limited health literacy. Using a hypothetical scenario, we assessed uncertainty about treatment preferences among 205 chronically ill, English/Spanish-speaking older adults from a county outpatient clinic in San Francisco. Participants were read a scenrio that described a very poor health state and poor outcome of life support treatment. Participants were asked to imagine that they were in this scenario and to choose either: all life support treatments; try life support with an option of stopping; or no life support. They were then asked how certain they were about this decision. Forty-five percent of participants were uncertain about their decision. In adjusted multivariate analysis, Latinos and Asian/Pacific Islanders were more likely than Whites to be uncertain about their treatment decisions, as were participants with limited versus adequate literacy and poor versus good self-rated health. Many patients may be uncertain about advance treatment preferences. Culturally sensitive, literacy-appropriate tools are needed to address decisional uncertainty and to help patients prepare for decision making about their future health care.
与预先治疗决策相关的复杂性可能导致决策不确定性和信息不足的选择，特别是在弱势群体中，如少数民族和健康素养有限的患者。我们使用一个假设情景，评估了来自旧金山县门诊诊所的 205 名慢性疾病、英语/西班牙语患者对治疗偏好的不确定性。向参与者阅读了一个描述非常糟糕的健康状况和生命支持治疗结果不佳的情景。要求参与者想象自己处于这种情况下，并选择以下三种治疗方案：所有生命支持治疗；尝试生命支持并可选择停止；或不进行生命支持。然后，他们被要求对这个决定的确定程度。45%的参与者对他们的决定不确定。在调整后的多变量分析中，与白人相比，拉丁裔和亚太裔更有可能对他们的治疗决策不确定，文化程度有限的参与者比文化程度足够的参与者更有可能对他们的治疗决策不确定，自我评估健康状况差的参与者比自我评估健康状况好的参与者更有可能对他们的治疗决策不确定。许多患者可能对预先治疗偏好不确定。需要文化敏感、适合读写能力的工具来解决决策不确定性，并帮助患者为未来的医疗保健决策做好准备。
