预立医疗指示对做出良好的临终决策有帮助吗：一项针对卫生专业人员的横断面调查
Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.
作者信息
Peicius Eimantas, Blazeviciene Aurelija, Kaminskas Raimondas
机构信息
Department of Social Sciences and Humanities, Medical Academy Lithuanian University of Health Sciences, Mickevičiaus g. 9, Kaunas, LT-44307, Lithuania.
Department of Nursing and Care, Medical Academy Lithuanian University of Health Sciences, Mickevičiaus g. 9, Kaunas, LT-44307, Lithuania.
出版信息
BMC Med Ethics. 2017 Jun 5;18(1):40. doi: 10.1186/s12910-017-0197-6.
BACKGROUND
This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania.
METHODS
A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods.
RESULTS
The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives.
CONCLUSIONS
The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.
背景
本文参与了关于在应用预先指示来管理临终护理决策过程时卫生专业人员角色变化的辩论。与预先指示相关的问题在立陶宛的临床科室中出现；然而，立陶宛仍是欧盟中少数几个未将预先指示的讨论纳入医疗保健政策制定议程的国家之一。为鼓励对预先指示的讨论，设计了一项研究以检查卫生专业人员对预先指示的理解和偏好。此外，该研究还试图探讨立陶宛医疗保健专业人员对预先指示在临床实践中应用的看法。
方法
通过对立陶宛考纳斯区主要医疗保健中心的478名卫生专业人员进行访谈开展了一项横断面调查。该研究的设计包括使用为本研究开发并经预试验验证的问卷。使用标准描述性统计方法对收集的数据进行分析。
结果
在比较受访者的职业和性别时，对预先指示知识的分析显示出一些具有统计学意义的差异。分析还表明受访者中出现的关键主题包括内心平静、尽可能长的预期寿命和选择自由。此外，研究结果显示，超过一半的研究参与者更愿意在生前通过预先指示来表达自己的意愿。
结论
研究结果显示卫生专业人员对预先指示的了解程度较低。大多数卫生专业人员同意预先指示改善了临终决策，而大多数医生赞赏预先指示是立陶宛临床实践中分担责任的最佳工具。比起护士，更多医生希望有预先指示来支持他们在临终情况下的决策。
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