Inoue Megumi, Tompkins Catherine, Scruggs Kiersten, Robles Jennifer
a Department of Social Work , George Mason University , Fairfax , Virginia , USA.
b INOVA Health System , Falls Church , Virginia , USA.
J Soc Work End Life Palliat Care. 2018 Apr-Sep;14(2-3):177-193. doi: 10.1080/15524256.2018.1460742. Epub 2018 May 29.
To encourage citizens to plan their end-of-life care to protect their autonomy, Congress passed the Patient Self-Determination Act (PSDA) in 1990. Under the PSDA, all Medicare/Medicaid-funded agencies are required to ask if all the patients, upon admission, have advance directives (ADs). If they have not formulated an AD, agencies need to inform that they have a right to do so and provide them with the written information. Although this is required by law, there is no universal procedure or set standard approach to deliver the information to patients in these agencies. It is often unclear who provides and explains information on ADs, and what materials are provided. The purpose of this study was to understand the procedures and challenges presented in the delivery of information about ADs in agencies in response to the PSDA requirements. Using a case study approach, semi-structured interviews with personnel in nine agencies were analyzed and three overarching themes were identified: organizational procedures, staff interactions, and staff perceptions. The findings indicated that there is a need for AD-specific training for staff responsible for delivering AD information to their clients. Implementation of a formalized procedure/guidelines for information delivery would be helpful to maintain quality standards across agencies.
为鼓励公民规划临终护理以保护其自主权，国会于1990年通过了《患者自决法案》（PSDA）。根据PSDA，所有由医疗保险/医疗补助计划资助的机构都必须询问所有患者在入院时是否有预先医疗指示（ADs）。如果患者尚未制定ADs，机构需要告知他们有权这样做并向他们提供书面信息。尽管这是法律要求，但在这些机构中，没有通用的程序或既定的标准方法来向患者提供信息。通常不清楚谁提供和解释有关ADs的信息，以及提供哪些材料。本研究的目的是了解各机构在响应PSDA要求时提供ADs信息的程序和挑战。采用案例研究方法，对九个机构的人员进行了半结构化访谈，并确定了三个总体主题：组织程序、员工互动和员工认知。研究结果表明，需要对负责向客户提供ADs信息的员工进行特定于ADs的培训。实施正式的信息传递程序/指南将有助于在各机构中维持质量标准。
