Pirinea Heather, Simunich Thomas, Wehner Daniel, Ashurst John
Department of Emergency Medicine, Memorial Medical Center, Johnstown, PA, USA.
Department of Research, Memorial Medical Center, Johnstown, PA, USA.
Indian J Palliat Care. 2016 Oct-Dec;22(4):432-436. doi: 10.4103/0973-1075.191784.
Advance directives and end of life care are difficult discussions for both patients and health-care providers (HCPs). A HCP requires an accurate understanding of advanced directives to educate patients and their family members to allow them to make an appropriate decision. Misinterpretations of the do not resuscitate (DNR), do not intubate (DNI), and the Physicians Orders for Life-Sustaining Treatment (POLST) form result in ineffective communication and confusion between patients, family members, and HCPs.
An anonymous, multiple choice online and paper survey was distributed to patients, family members of patients (PFMs), and HCPs from December 12, 2012 to March 6, 2013. Data regarding demographics, the accuracy of determining the correct definition of DNR and DNI, the familiarity of the POLST form and if a primary care physician had discussed advanced directives with the participants were collected.
A total of 687 respondents participated in the survey. Patients and PFMs could not distinguish the definition of DNR (95% confidence interval [CI] [1.453-2.804]) or DNI (95% CI (1.216-2.334)) 52% of the time while HCPs 35% and 39% of the time ( < 0.0005). Regarding the POLST form, 86% of patients and PFMs and 50% of HCPs were not familiar with the POLST form. Sixty-nine percent of patients and family members reported that their primary care physician had not discussed advance directives with them. Twenty-four percent of patients and family members reported that they had previous health-care experience and this was associated with increased knowledge of the POLST form ( < 0.0005). An association was also seen between the type of HCP taking the survey and the ability to correctly identify the correct definition of DNR ( < 0.0005).
Discussion of end of life care is difficult for patients and their family members. Often times multiple discussions are required in order to effectively communicate the definition of DNR, DNI, and the POLST form. Education of patients, family members, and HCPs is required to bridge the knowledge gap of advance directives.
对患者和医疗保健提供者（HCPs）而言，预立医疗指示和临终关怀都是难以进行的讨论。HCPs需要准确理解预立医疗指示，以便对患者及其家属进行教育，使其能够做出恰当的决定。对“不要复苏”（DNR）、“不要插管”（DNI）以及“医生维持生命治疗医嘱”（POLST）表格的误解，会导致患者、家属和HCPs之间沟通无效和产生困惑。
从2012年12月12日至2013年3月6日，向患者、患者家属（PFMs）和HCPs发放了一份匿名的在线多项选择题纸质调查问卷。收集了有关人口统计学的数据、确定DNR和DNI正确定义的准确性、对POLST表格的熟悉程度，以及初级保健医生是否与参与者讨论过预立医疗指示的情况。
共有687名受访者参与了调查。患者和PFMs有52%的时间无法区分DNR（95%置信区间[CI][1.453 - 2.804]）或DNI（95% CI[1.216 - 2.334]）的定义，而HCPs分别有这一情况的时间为35%和39%（<0.0005）。关于POLST表格，86%的患者和PFMs以及50%的HCPs不熟悉该表格。69%的患者和家属表示，他们的初级保健医生没有与他们讨论过预立医疗指示。24%的患者和家属表示他们有过医疗保健经历，这与对POLST表格的了解增加相关（<0.0005）。参与调查的HCPs类型与正确识别DNR正确定义的能力之间也存在关联（<0.0005）。
对患者及其家属来说，临终关怀的讨论很困难。通常需要多次讨论才能有效地传达DNR、DNI和POLST表格的定义。需要对患者、家属和HCPs进行教育，以弥合预立医疗指示方面的知识差距。
