Chan Carmen W H, Wong Martin M H, Choi Kai Chow, Chan Helen Y L, Chow Amy Y M, Lo Raymond S K, Sham Michael M K
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
Asia Pac J Oncol Nurs. 2019 Jan-Mar;6(1):72-77. doi: 10.4103/apjon.apjon_38_18.
An advance directive (AD) is a document that allows mentally competent individuals to make healthcare decisions about their condition that they might no longer be able to make in the future. This study aimed to explore the perceptions of AD decision-making of various stakeholders in the Chinese palliative care setting.
Patients with life-limiting diseases, family members, health professionals, and hospital volunteers were recruited in the palliative care unit of two hospitals in Hong Kong by purposive sampling on age and sex. Qualitative semi-structured individual interviews were conducted.
A total of 96 participants, including 24 participants from each group, completed the study. Most participants were willing to discuss AD but had not heard about it before the interview. Patients regarded the decisions made in the AD as a way to reduce their future sufferings, while they also considered the welfare of their family. Family members were concerned about the psychological burden when discussing about the AD. Health professionals emphasized the logistic and process of the AD. Hospital volunteers pointed out the impact of Chinese culture on AD acceptance and the lack of AD promotion in the community.
The findings of the study indicated the need for more promotion of AD in the society. It is important to consider the opinion of a patient's family during AD discussions in a Chinese culture. Health professionals may need to identify the best timing for the discussion of AD with patients and their families.
预先指示（AD）是一份文件，允许心智健全的个人就其病情做出医疗保健决策，而这些决策他们日后可能无法再做出。本研究旨在探讨中国姑息治疗环境中各利益相关者对AD决策的看法。
通过按年龄和性别进行目的抽样，在香港两家医院的姑息治疗病房招募患有危及生命疾病的患者、家庭成员、卫生专业人员和医院志愿者。进行了定性的半结构化个人访谈。
共有96名参与者完成了研究，每组各24名。大多数参与者愿意讨论AD，但在访谈前并未听说过。患者将AD中做出的决策视为减轻未来痛苦的一种方式，同时他们也考虑到家人的福祉。家庭成员在讨论AD时担心心理负担。卫生专业人员强调AD的后勤工作和流程。医院志愿者指出了中国文化对AD接受度的影响以及社区中AD推广的不足。
研究结果表明社会需要更多地推广AD。在中文文化背景下进行AD讨论时，考虑患者家属的意见很重要。卫生专业人员可能需要确定与患者及其家属讨论AD的最佳时机。
