Hamada Shuhei, Haruta Junji, Hamano Jun, Maeno Takami, Maeno Tetsuhiro
Graduate School of Comprehensive Human Sciences University of Tsukuba Tsukuba Japan.
Faculty of Medicine University of Tsukuba Tsukuba Japan.
J Gen Fam Med. 2019 Feb 20;20(3):82-92. doi: 10.1002/jgf2.238. eCollection 2019 May.
Advance directives (ADs) are seldom discussed between primary care physicians (PCPs) and their patients, especially those with noncancer diseases. The aim was to identify the factors associated with discussing AD by noncancer patients with their physicians.
This cross-sectional study was conducted in a hospital or clinic from October to December 2017. Physicians chose eligible noncancer patients aged 20 years or older to respond to an anonymous self-completed questionnaire inquiring about the objective variable "I want to discuss AD with my doctor," as well as basic characteristics, and facilitators and barriers to discussing AD identified in previous studies. The physicians responded to a survey comprising the Palliative Performance Scale (PPS) and inquiring about the disease category for each patient. Data were analyzed using binomial logistic regression analysis.
A total of 270 patients (valid response rate, 79.6%) were included. Multivariate analysis identified a period of visit to the study site ≥ 3 years (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05-4.10), physicians who are very good at taking care of patients' disease (OR, 12.68; 95% CI, 1.12-143.22), and patients' worry about their quality of life (QOL) in the future (OR, 2.69; 95% CI, 1.30-5.57) as facilitators for discussing AD with physicians, and PPS ≤ 90 (OR, 0.51; 95% CI, 0.26-0.98) as a barrier.
Our study indicates that patients' future QOL concerns, a long period of visit to a hospital, and the presence of physical symptoms were associated with the willingness of noncancer patients to discuss AD with PCPs.
初级保健医生（PCP）与其患者，尤其是患有非癌症疾病的患者之间很少讨论预先指示（AD）。目的是确定非癌症患者与其医生讨论AD的相关因素。
这项横断面研究于2017年10月至12月在一家医院或诊所进行。医生选择年龄在20岁及以上的符合条件的非癌症患者，以回应一份匿名的自我填写问卷，该问卷询问客观变量“我想和我的医生讨论AD”，以及基本特征，以及先前研究中确定的讨论AD的促进因素和障碍。医生回应了一项包括姑息治疗表现量表（PPS）的调查，并询问了每位患者的疾病类别。使用二项逻辑回归分析对数据进行分析。
共纳入270例患者（有效回复率为79.6%）。多变量分析确定，在研究地点就诊时间≥3年（优势比[OR]，2.07；95%置信区间[CI]，1.05 - 4.10）、非常善于照顾患者疾病的医生（OR，12.68；95%CI，1.12 - 143.22）以及患者对未来生活质量（QOL）的担忧（OR，2.69；95%CI，1.30 - 5.57）是与医生讨论AD的促进因素，而PPS≤90（OR，0.51；95%CI，0.26 - 0.98）是一个障碍。
我们的研究表明，患者对未来生活质量的担忧、长期在医院就诊以及身体症状的存在与非癌症患者与初级保健医生讨论AD的意愿相关。
