Inserm U955, Université Paris Est Créteil (UPEC), Institut Mondor de Recherche Biomédicale (IMRB), équipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France; Assistance Publique-Hôpitaux de Paris, Joffre-Dupuytren Hospital, Geriatric Department, Draveil, F- 91210, France.
Assistance Publique-Hôpitaux de Paris, Charles Foix Hospital, Geriatric Department, Ivry-sur-seine, F- 94200, France.
Patient Educ Couns. 2020 Jul;103(7):1390-1398. doi: 10.1016/j.pec.2020.01.020. Epub 2020 Jan 31.
To assess levels of knowledge about patients' rights, surrogate decision-makers, and advance directives among healthcare professionals at three hospitals in France.
A multicenter, cross-sectional study in three geriatric hospitals in the Paris area (France) in 2015. The participants' level of knowledge was assessed via an 18-item self-questionnaire on surrogate decision-makers, advance directives, and end-of-life decision-making. The characteristics associated with a good level of knowledge were assessed using logistic regression.
Among the 301 healthcare professionals (median ± standard deviation age: 40.4 ± 10.2 years; women: 73.4 %), only 15.0 % (95 % confidence interval (CI): [19.7-29.5]) correctly answered at least 75 % of the questions on patients' rights. Respectively 24.6 % [19.7-29.5], 36.5 % [31.1-42.0] and 37.5 % [32.0-43.0] had sufficient knowledge regarding "surrogate decision-maker", "advance directives", and "decision-making at the end of life". In a multivariable analysis, the only factor significantly associated with a good level of knowledge about end-of-life policy was employment in a university hospital, with a non-significant trend for status as a physician.
Our survey of staff working in geriatric care units highlighted the poor overall level of knowledge about healthcare surrogates and advance directives; the results suggest that additional training in these concepts is required.
Continuing education of healthcare professionals on advance directives and surrogate decision-maker should be promoted to ensure rights of elderly patients at the end of life.
评估法国三家医院的医疗保健专业人员对患者权利、代理人和预先指示的知识水平。
这是一项 2015 年在巴黎地区（法国）三家老年医院进行的多中心、横断面研究。通过一份关于代理人、预先指示和临终决策的 18 项自我问卷评估参与者的知识水平。使用逻辑回归评估与良好知识水平相关的特征。
在 301 名医疗保健专业人员中（中位数±标准差年龄：40.4±10.2 岁；女性：73.4%），只有 15.0%（95%置信区间（CI）：[19.7-29.5]）正确回答了至少 75%的患者权利问题。分别有 24.6%（19.7-29.5）、36.5%（31.1-42.0）和 37.5%（32.0-43.0）对“代理人”、“预先指示”和“生命末期决策”有足够的了解。在多变量分析中，唯一与临终政策知识水平良好相关的因素是在大学医院工作，医生身份有不显著的趋势。
我们对老年护理病房工作人员的调查突出了他们对医疗代理人和预先指示的总体知识水平较差；结果表明，需要进一步培训这些概念。
应促进医疗保健专业人员关于预先指示和代理人的继续教育，以确保老年患者在生命末期的权利。
