Department of Radiation Oncology, Interdisciplinary Center of Palliative Care, University of Würzburg, Josef-Schneider-Str. 2, 97070 Würzburg, Germany.
Support Care Cancer. 2012 Nov;20(11):2729-36. doi: 10.1007/s00520-012-1394-y.
Advance directives (AD) are becoming increasingly widespread. We examine the prevalence of AD and the factors associated with AD in tumor patients during radiotherapy.
A standardized questionnaire was handed out to all tumor patients on 9 random days with an interval of at least 12 weeks. The data were analyzed in a bivariate and multivariate way.
Of 1,208 questionnaires, 658 were completed and returned (54.5%). Of respondents, 23.6% had already signed an AD, 53.3% thought they were likely to sign an AD, 9.0% did not want to sign an AD, and 4.9% were not familiar with advance directives. Patients who have signed an AD and those who are likely to sign one think that ADs facilitate the physician's decision-making process (97.7% cf. 94.5%) and that they ease the burden on relatives (98.5% cf. 98.8%). Regardless of an AD having been signed, every second respondent was of the opinion that AD facilitates consultations rather than serving as a directive (55.1% cf. 57.3%). Patients likely to sign an AD are significantly younger compared to those unlikely to do so and have suffered from their tumor disease for a shorter period of time.
Of advance directives is widely accepted among the tumor patients surveyed. Advanced directives are not exclusively seen as instruments for surrogate decision making, but also as mediums to improve communication. Training of physicians and additional offers for patients could increase the actual number of ADs and perhaps improve physicians and relatives understanding of patients needs and wishes.
预先指示（AD）越来越普及。我们研究了肿瘤患者在放疗期间 AD 的流行情况以及与 AD 相关的因素。
在 9 个随机日向所有肿瘤患者发放了标准化问卷，间隔至少 12 周。对数据进行了双变量和多变量分析。
在 1208 份问卷中，有 658 份完成并返回（54.5%）。在回答者中，23.6%已经签署了 AD，53.3%认为他们可能会签署 AD，9.0%不想签署 AD，4.9%不熟悉预先指示。已经签署 AD 和可能签署 AD 的患者认为 AD 有助于医生的决策过程（97.7% 对比 94.5%），并减轻了亲属的负担（98.5% 对比 98.8%）。无论是否签署了 AD，每两个受访者中就有一个人认为 AD 有助于咨询，而不是作为指令（55.1% 对比 57.3%）。可能签署 AD 的患者明显比不太可能签署 AD 的患者年轻，且患病时间较短。
调查的肿瘤患者广泛接受预先指示。预先指示不仅被视为替代决策的工具，而且还被视为改善沟通的媒介。对医生的培训和为患者提供更多选择可以增加实际的 AD 数量，并可能改善医生和亲属对患者需求和意愿的理解。
