de Caprariis Pascal J, Rucker Bronwyn, Lyon Claudia
From the Departments of Medicine and Family Medicine, and the Division of General Internal Medicine and Clinical Innovation, NYU Lutheran Medical Center, Brooklyn, and the Palliative Care Consulting Service, Brooklyn Hospital Center, Brooklyn, New York.
South Med J. 2017 Sep;110(9):563-568. doi: 10.14423/SMJ.0000000000000697.
The concept of end-of-life planning, along with medical and legal issues, has been discussed and has evolved over several years. The 1990 Patient Self-Determination Act and individual states' Department of Health Advance Directive forms helped overcome past problems. Patients with terminal and chronic illness are now able to have their wishes recognized for their future care. Any healthy individual's decision during an advance care planning (ACP) discussion can be adversely affected by various factors; however, multiple barriers-religion, culture, education, and family dynamics-can influence the process. Healthcare professionals' reluctance to initiate the conversation may result from limited training during medical school and residency programs. These limitations hinder both the initiation and productiveness of an ACP conversation. We explored ACP issues to provide guidance to healthcare professionals on how best to address this planning process with a healthy adult.
临终规划的概念，连同医学和法律问题，已经讨论了数年并不断演变。1990年的《患者自主决定法案》以及各州卫生部的预先指示表格帮助克服了过去的问题。患有晚期和慢性疾病的患者现在能够让他们对未来护理的意愿得到认可。在预先护理计划（ACP）讨论中，任何健康个体的决定都可能受到各种因素的不利影响；然而，宗教、文化、教育和家庭动态等多重障碍会影响这一过程。医疗保健专业人员不愿开启对话可能源于医学院和住院医师培训项目期间有限的培训。这些限制阻碍了ACP对话的开启和成效。我们探讨了ACP问题，以便为医疗保健专业人员提供指导，说明如何最好地与健康成年人进行这一规划过程。
