Dubbert Patricia M, Garner Kimberly K, Lensing Shelly, White J Glen, Sullivan Dennis H
VISN 16/CAVHS Geriatric Research Education and Clinical Center.
Mental Health Service, Central Arkansas Veterans Healthcare System.
Psychol Serv. 2017 May;14(2):214-220. doi: 10.1037/ser0000147.
Communicating health care preferences in advance, so that wishes can be honored if the person becomes unable to participate in decision-making, is especially important for vulnerable populations such as homeless veterans. Hospitals are required to inform patients of their rights to document their preferences, but completion rates for advance directives are low. Conceptualizing advance health care planning as a series of health behavior steps emphasizing communication is recommended for improving engagement in advance health care planning. The authors used program evaluation data from psychoeducational groups with 288 homeless veterans to learn about their previous experience with different steps of advance health care planning and their personal goals for future steps. Results revealed a significant discrepancy between what these veterans reported they have done and information available to health care providers in the medical record: Only 26% had an advance directive in the medical record, but 70% reported they had thought about the care they would want, and almost half reported they had talked with a trusted other or named someone to make decisions for them. The most frequent goal endorsed by veterans attending groups was discussing advance health care planning with family or trusted others and/or naming someone to be a decision maker. These findings indicate a need for improved communication and documentation of veteran preferences about emergency and end of life care. Results are also consistent with interventions tailored to varying readiness for different steps of advance health care planning. (PsycINFO Database Record
提前沟通医疗保健偏好，以便在个人无法参与决策时其愿望能够得到尊重，这对于无家可归的退伍军人等弱势群体尤为重要。医院必须告知患者记录其偏好的权利，但预先指示的完成率很低。建议将提前医疗保健规划概念化为一系列强调沟通的健康行为步骤，以提高对提前医疗保健规划的参与度。作者使用了来自288名无家可归退伍军人的心理教育小组的项目评估数据，以了解他们在提前医疗保健规划不同步骤中的既往经历以及他们对未来步骤的个人目标。结果显示，这些退伍军人报告的他们已做之事与医疗记录中医疗保健提供者可获得的信息之间存在显著差异：只有26%的人在医疗记录中有预先指示，但70%的人报告他们曾考虑过自己想要的护理，近一半的人报告他们曾与信任的他人交谈或指定他人为他们做决定。参加小组的退伍军人最常认可的目标是与家人或信任的他人讨论提前医疗保健规划和/或指定某人作为决策者。这些发现表明需要改善关于退伍军人对紧急情况和临终护理偏好的沟通与记录。结果也与针对提前医疗保健规划不同步骤的不同准备程度量身定制的干预措施一致。（PsycINFO数据库记录）
