Department of Psychiatry, The Chinese University of Hong Kong, Shatin, NT, HKSAR.
Aging Ment Health. 2010 Nov;14(8):994-9. doi: 10.1080/13607863.2010.501065.
With increasing longevity, there is an increasing need for medical professionals to face situations in which explanation for decision on life-sustaining treatment (LST) would be required.
As advance decision making for LST in case of severe medical illness may be unfamiliar for most of the Chinese elders, we aim to explore if procedures adopted to enhance the exposure to the issue concerned would bring about improvement in knowledge toward decision for LST.
This was a cross-sectional study. The design was divided into three sections: (i) a pre-scenario knowledge assessment, (ii) scenario exposure (relating issues of LST using case vignettes), and (iii) a post-scenario assessment. The pre- and post-scenario assessment comprises 10 questions, exploring the understanding toward basic issues related to LST. The scenario exposure comprises two hypothetical case vignettes describing situations demanding decisions for LST. The knowledge level toward LST was assessed and compared before and after the presentation of the two vignettes.
One-hundred community dwelling older persons (aged over 60 years) were recruited. The scenario exposure improved the knowledge level of participants (paired samples t-test, p < 0.05). Participants who were younger and better educated were more likely to perform better in the knowledge test (bivariate correlation and logistic regression, p < 0.05).
The results demonstrated that hypothetical scenarios may help to enhance and facilitate the understanding of LST. The study should be carried forward to explore the applicability of enhancement procedure to facilitate the decision making for advance directives and LST in the older community.
随着寿命的延长，越来越需要医疗专业人员面对需要对维持生命的治疗（LST）做出解释的情况。
由于大多数中国老年人对严重疾病时的 LST 预先决策可能不熟悉，我们旨在探讨增强对相关问题的认识的程序是否会提高对 LST 决策的知识。
这是一项横断面研究。设计分为三个部分：（i）情景前知识评估，（ii）情景暴露（使用病例简述描述 LST 相关问题），和（iii）情景后评估。情景前和情景后评估包括 10 个问题，探讨与 LST 相关的基本问题的理解。情景暴露包括描述需要进行 LST 决策的两种假设病例简述。评估 LST 的知识水平，并在呈现两个病例简述前后进行比较。
招募了 100 名居住在社区的老年人（年龄在 60 岁以上）。情景暴露提高了参与者的知识水平（配对样本 t 检验，p<0.05）。年轻和受教育程度较高的参与者在知识测试中表现更好（双变量相关性和逻辑回归，p<0.05）。
结果表明，假设情景可能有助于增强和促进对 LST 的理解。应进一步开展研究，探讨增强程序在促进老年人社区中预先指令和 LST 决策中的适用性。
