Oriakhi Michael, Sealy Charlene, Adenote Abimbola, Alabi Olutoyin, Ahluwalia Meena
Department of Medicine, Harlem Hospital Center, New York, NY, USA.
Resident, Department of Internal Medicine, Harlem Hospital Center, New York, NY.
J Community Hosp Intern Med Perspect. 2019 Nov 1;9(5):419-421. doi: 10.1080/20009666.2019.1643218. eCollection 2019.
: Advance directives have been established as a legal document that ensures patients' wishes are followed if/when they cannot make medical decisions for themselves. The concept, advance directive, is rooted in the ethical principle of patient's autonomy. New York State recognizes three types of advance directives: New York State Health Care Proxy, Living Wills, and Do Not Resuscitate (DNR) order. A common misnomer in healthcare is the idea that advance directives are for the elderly or patients with terminal illness. As per New York State statutes, everyone older than 18-years-old should have an advance directive to avoid conflicts in times of crisis. It has been shown that most patients believe it is their physician's responsibility to initiate an advance directive discussion and residents are at the forefront of most health facilities. : To assess the knowledge and attitude of internal medicine residents towards advance directive and to improve residents' skills and confidence on advance directive discussion. : We carried out a prospective study to assess the knowledge and attitude of the internal medicine residents towards advance directive to validate the need to implement didactic sessions and simulations. : Fifty out of the 75 internal medicine residents of Harlem Hospital Center participated in the study. Most of the responders indicated that they lacked sufficient knowledge in advance directive discussion and indicated that they were interested in didactic sessions and simulations related to how to help patients with advance directives. : Our study showed that most of the residents lacked sufficient knowledge in advance directives discussions and the importance of its incorporation into residency training education.
预先指示已被确立为一种法律文件，可确保在患者无法自行做出医疗决策时/如果他们无法自行做出医疗决策，其意愿能够得到遵循。“预先指示”这一概念植根于患者自主权的伦理原则。纽约州认可三种类型的预先指示：纽约州医疗保健代理人、生前遗嘱和不要复苏（DNR）医嘱。医疗保健领域一个常见的错误观念是，认为预先指示是针对老年人或绝症患者的。根据纽约州法规，每个18岁以上的人都应该有一份预先指示，以避免在危机时刻出现冲突。研究表明，大多数患者认为发起预先指示讨论是医生的责任，而住院医师处于大多数医疗机构的前沿。
为评估内科住院医师对预先指示的知识和态度，并提高住院医师在预先指示讨论方面的技能和信心。
我们开展了一项前瞻性研究，以评估内科住院医师对预先指示的知识和态度，从而验证开展教学课程和模拟的必要性。
哈莱姆医院中心75名内科住院医师中有50人参与了该研究。大多数受访者表示，他们在预先指示讨论方面缺乏足够的知识，并表示他们对与如何帮助患者制定预先指示相关的教学课程和模拟感兴趣。
我们的研究表明，大多数住院医师在预先指示讨论方面缺乏足够的知识，以及将其纳入住院医师培训教育的重要性。
