Arita Ken-ichi, Ikegami Yasuhiko
Department of Respiratory Disease, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital.
Nihon Ronen Igakkai Zasshi. 2012;49(3):318-24. doi: 10.3143/geriatrics.49.318.
We distributed 282 questionnaires to doctors to ascertain their opinions on obtaining the advance directives regarding the end-of-life treatment of patients at the terminal stage. We received 136 (48%) responses.
A total of 62% of the respondents stated a desire for patients to indicate their advance directives "if at all possible". Only 36% stated that the need for advance directives "depended on the circumstances". A total of 80% of doctors aged under 40 wished patients to provide advanced directives "if at all possible", while 59% of doctors over 61 wanted advanced directives "depending on the circumstances" (p=0.008). A large number of doctors stated a desire for patients to indicate their preference in writing, particularly directives regarding the "use of a ventilator to prolong life" (76%) or the "use of artificial nourishment through a gastric fistula etc. as part of a proactive approach to sustaining life" (67%). Regarding the optimal timing of this declaration, 59% chose "at the first diagnosis of a terminal illness", and 47% chose "at the diagnosis of a chronic illness", regardless of whether it could become terminal. Of those respondents under 40, 32% believed that doctors should strictly follow the patients' advance directives, while only 11% of doctors over 61 years old believed the same. There was a statistically significant relationship between aging and dealing with advance directives of patients in the terminal stages of illness (p=0.002).
These results suggest that doctors under 40 years of age should focus on how to correctly interpret the wishes of the patients expressed in the directives, while doctors over 61 should concentrate on the importance of the clinical application of advance directives, and how to balance the need to make qualified medical decisions on treatment in compliance with the wishes of end-stage terminal patients.
我们向医生发放了282份问卷，以了解他们对于获取关于终末期患者临终治疗的预先指示的看法。我们收到了136份（48%）回复。
共有62%的受访者表示希望患者“如果可能的话”表明其预先指示。只有36%的人表示对预先指示的需求“取决于具体情况”。40岁以下的医生中，共有80%希望患者“如果可能的话”提供预先指示，而61岁以上的医生中，59%希望根据“具体情况”制定预先指示（p = 0.008）。大量医生表示希望患者以书面形式表明其偏好，特别是关于“使用呼吸机延长生命”（76%）或“通过胃造瘘等使用人工营养作为维持生命的积极措施的一部分”（67%）的指示。关于这一声明的最佳时机，59%的人选择“在首次诊断为绝症时”，47%的人选择“在诊断为慢性病时”，无论其是否可能发展为绝症。在40岁以下的受访者中，32%认为医生应严格遵循患者的预先指示，而61岁以上的医生中只有11%持相同看法。在处理绝症末期患者的预先指示方面，年龄与处理方式之间存在统计学上的显著关系（p = 0.002）。
这些结果表明，40岁以下的医生应专注于如何正确解读指示中表达的患者意愿，而61岁以上的医生应专注于预先指示临床应用的重要性，以及如何平衡根据末期绝症患者意愿做出合格医疗决策的需求。
