Hinderer Katherine A, Lee Mei Ching
Salisbury University, Department of Nursing, Salisbury, MD 21801, USA.
University of Maryland, Baltimore, School of Nursing, Organizational Systems & Adult Health, Baltimore, MD 21201, USA.
Appl Nurs Res. 2014 Feb;27(1):84-6. doi: 10.1016/j.apnr.2013.10.004. Epub 2013 Oct 28.
Advance directives (AD) and advance care planning (ACP) are critical to making patient-centered end-of-life decisions. Despite their importance, completion rates for AD in the United States remain low at about 18-36%. Lack of education related to AD and not understanding AD have been cited as key reasons for not participating in ACP or completing AD.
The purpose of this quasi-experimental pilot study was to assess the effectiveness of a nurse led educational AD seminar that used the Five Wishes on attitudes related to AD, AD completion, and participation in ACP conversations.
A post-test repeated measures design was used.
Of the 86 participants who attended the seminar, most (n=71, 82.6%) found the seminar useful, and 97.7% (n=84) reported that they were likely to complete an AD and participate in ACP conversations with family or friends. Overall attitudes about ADs were high. Older females were more likely to complete AD than their younger male counterparts, and women were more likely than men to have ACP conversations.
The results of this study lend support to the role of nursing-driven community-based educational interventions to improve AD completion and participation in the ACP process.
预立医疗指示（AD）和预立医疗照护计划（ACP）对于做出以患者为中心的临终决策至关重要。尽管其很重要，但在美国，AD的完成率仍然很低，约为18%-36%。缺乏与AD相关的教育以及不理解AD被认为是不参与ACP或完成AD的关键原因。
这项准实验性试点研究的目的是评估由护士主导、使用《五个愿望》的AD教育研讨会对与AD相关的态度、AD的完成情况以及参与ACP对话的有效性。
采用后测重复测量设计。
在参加研讨会的86名参与者中，大多数（n=71，82.6%）认为研讨会有用，97.7%（n=84）报告称他们可能会完成一份AD并与家人或朋友参与ACP对话。对AD的总体态度较高。老年女性比年轻男性更有可能完成AD，女性比男性更有可能进行ACP对话。
本研究结果支持了以护理为主导的社区教育干预在提高AD完成率和参与ACP过程方面的作用。
