Markham Sarah A, Levi Benjamin H, Green Michael J, Schubart Jane R
Department of Humanities, The Pennsylvania State University, College of Medicine.
Departments of Surgery and Medicine, The Pennsylvania State University, College of Medicine.
J Natl Med Assoc. 2015 Feb;107(1):26-32. doi: 10.1016/S0027-9684(15)30006-7. Epub 2015 Dec 2.
The authors wish to acknowledge the support and assistance of Dr. William Lawrence for his contribution to the M.A.UT model used in the decision aid, Making Your Wishes Known: Planning Your Medical Future (MYWK), Dr. Cheryl Dellasega for her leadership in focus group activities, Charles Sabatino for his review of legal aspects of MYWK, Dr. Robert Pearlman and his collaborative team for use of the advance care planning booklet "Your Life, Your Choices," Megan Whitehead for assistance in grant preparation and project organization, and the Instructional Media Development Center at the University of Wisconsin as well as JPL Integrated Communications for production and programming of MYWK.
For various cultural and historical reasons, African Americans are less likely than Caucasians to engage in advance care planning (ACP) for healthcare decisions.
This pilot study tested whether an interactive computer program could help overcome barriers to effective ACP among African Americans.
African American adults were recruited from traditionally Black churches to complete an interactive computer program on ACP, pre-/post-questionnaires, and a follow-up phone interview.
Eighteen adults (mean age =53.2 years, 83% female) completed the program without any problems. Knowledge about ACP significantly increased following the computer intervention (44.9% → 61.3%, p=0.0004), as did individuals' sense of self-determination. Participants were highly satisfied with the ACP process (9.4; 1 = not at all satisfied, 10 = extremely satisfied), and reported that the computer-generated advance directive accurately reflected their wishes (6.4; 1 = not at all accurate, 7 = extremely accurate). Follow-up phone interviews found that >80% of participants reported having shared their advance directives with family members and spokespeople.
Preliminary evidence suggests that an interactive computer program can help African Americans engage in effective advance care planning, including creating an accurate advance directive document that will be shared with loved ones.
作者谨此感谢威廉·劳伦斯博士博士博士博士对决策辅助工具《说出你的愿望：规划你的医疗未来》（MYWK）中使用的MAUT模型所做的贡献；感谢谢丽尔·德拉塞加博士在焦点小组活动中的领导作用；感谢查尔斯·萨巴蒂诺对MYWK法律方面的审核；感谢罗伯特·珀尔曼博士及其合作团队允许使用预先护理计划手册《你的生活，你的选择》；感谢梅根·怀特黑德在拨款准备和项目组织方面提供的帮助；感谢威斯康星大学教学媒体开发中心以及喷气推进实验室综合通信部对MYWK的制作和编程。
由于各种文化和历史原因，非裔美国人比白种人更不太可能参与医疗保健决策的预先护理计划（ACP）。
这项试点研究测试了一个交互式计算机程序是否有助于克服非裔美国人有效进行ACP的障碍。
从传统黑人教堂招募非裔美国成年人，以完成关于ACP的交互式计算机程序、前后调查问卷以及后续电话访谈。
18名成年人（平均年龄 =53.2岁，83%为女性）顺利完成了该程序。经过计算机干预后，参与者对ACP的知识显著增加（从44.9%增至61.3%，p =0.0004），个人的自主意识也有所增强。参与者对ACP过程高度满意（9.4分；1分为完全不满意，10分为极其满意），并表示计算机生成的预先医疗指示准确反映了他们的愿望（6.4分；1分为完全不准确，7分为极其准确）。后续电话访谈发现，超过80%的参与者报告称已与家人和代言人分享了他们的预先医疗指示。
初步证据表明，一个交互式计算机程序可以帮助非裔美国人有效地参与预先护理计划，包括创建一份将与亲人分享的准确的预先医疗指示文件。
