Kuldeep N. Yadav is a research coordinator in the Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
Nicole B. Gabler is a senior research investigator in the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania.
Health Aff (Millwood). 2017 Jul 1;36(7):1244-1251. doi: 10.1377/hlthaff.2017.0175.
Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record.
努力促进预立医疗指示的完成,这隐含地假设这些文件(在丧失能力的情况下有助于确保医疗服务符合个人偏好)的完成率不理想。然而,关于美国完成预立医疗指示的数据并不一致,质量也参差不齐。我们系统地回顾了 2011-2016 年期间发表的研究,以确定有多少美国成年人完成了生前预嘱、医疗保健授权书或两者都有。在我们分析的 150 项研究中的 795909 人中,有 36.7%的人完成了预立医疗指示,其中 29.3%的人有生前预嘱。在审查的这些年中,这些比例相似。有慢性疾病的患者(38.2%)和健康成年人(32.7%)有相似比例的人完成了预立医疗指示。这些发现为衡量未来旨在激励完成预立医疗指示的政策和实践提供了基准,特别是在那些最有可能从记录这些文件中受益的人群中。