Buiar Pedro Grachinski, Goldim José Roberto
Medical Oncology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-007, Brazil.
http://orcid.org/0000-0001-5144-1197.
Ecancermedicalscience. 2019 Nov 12;13:974. doi: 10.3332/ecancer.2019.974. eCollection 2019.
The advance directive (AD) is an important resource in oncology and all areas of medicine directly involved in the care of palliative patients. It provides people with the right to have their living wills honoured when they cannot respond by themselves. Despite their importance, ADs are still underused in most countries due to multiple factors. The objective of this review is to better categorise the barriers and difficulties that could impair the composition and implementation of ADs, allowing direct efforts against these obstacles. After the literature review, we believe that there would be five steps in the trajectory of an AD (discussion, composition, registration, access and implementation) and that all those steps can be affected by factors involving the health systems and professionals, the patient themselves and relatives or caregivers.
预先指示（AD）是肿瘤学以及直接参与姑息治疗患者护理的所有医学领域的一项重要资源。它赋予人们在无法自行回应时，其生前遗嘱得到尊重的权利。尽管预先指示很重要，但由于多种因素，在大多数国家它们仍未得到充分利用。本综述的目的是更好地对可能妨碍预先指示的制定和实施的障碍与困难进行分类，以便能直接应对这些障碍。在文献综述之后，我们认为预先指示的过程会有五个步骤（讨论、制定、登记、获取和实施），并且所有这些步骤可能会受到涉及卫生系统和专业人员、患者本人以及亲属或护理人员等因素的影响。
