Lopez Ruth Palan, Guarino A J
MGH Institute of Health Professions School of Nursing, Boston, MA 02129-4557, USA.
Clin Nurs Res. 2011 Aug;20(3):228-40. doi: 10.1177/1054773811405521.
Uncertainty is a significant barrier confronting surrogate decision makers(SDMs) who make treatment decisions for nursing home (NH) residents with dementia. The study purpose is to describe uncertainty among SDMs of NH residents with dementia and to identify factors associated with greater Uncertainty. We employed a nonexperimental, cross-sectional design using mailed survey and recruited 155 SDM participants from eight NHs in New England. The survey contained the Mishel Uncertainty in Illness Scale For Family Members. Independent variables included resident and SDM sociodemographic characteristics, Advance Directives, Credible Authority, Social Support, and Perceived Self-Efficacy for Surrogate Decision Making. Results of a simultaneous multiple regression analysis identified Perceived Self-Efficacy,Social Support, and Close Relative explained 22% of the Uncertainty variance.These findings suggest that close family relatives who serve as SDMs for NH residents with dementia may benefit from increasing social support and enhancing SDMs’ self-efficacy for decision making.
不确定性是代行决策人（SDMs）在为患有痴呆症的养老院（NH）居民做出治疗决策时面临的一个重大障碍。本研究的目的是描述患有痴呆症的NH居民的代行决策人所面临的不确定性，并确定与更高不确定性相关的因素。我们采用了邮寄调查的非实验性横断面设计，从新英格兰的8家NH招募了155名代行决策人参与者。该调查包含了针对家庭成员的米歇尔疾病不确定性量表。自变量包括居民和代行决策人的社会人口学特征、预立医疗指示、可靠权威、社会支持以及代行决策的自我效能感。同时进行的多元回归分析结果表明，自我效能感、社会支持和近亲这几个因素解释了22%的不确定性差异。这些发现表明，作为患有痴呆症的NH居民代行决策人的近亲，可能会从增加社会支持和提高代行决策人的决策自我效能感中受益。
