Gilligan M A, Jensen N
Department of Medicine, University of Washington, Seattle.
Wis Med J. 1995;94(5):239-43.
Advance directives (ADs) are instructions from patients to their physician and family regarding their wishes for medical care in the event they become incapable of communicating those wishes. This study sought to describe the characteristics of adults who have completed advance directives and those who have expressed interest in them, and to determine what distinguishes these groups from the group with no interest in ADs. A further objective was to survey the study population on the barriers to completion of ADs. A random sample of 160 outpatients visiting one of three clinics (General Internal Medicine Clinic (GIM), HIV Clinic, and Oncology Clinic) were selected for the study. A 10-item questionnaire was administered which included questions on familiarity with, sources of information on, and interest in ADs. Demographic information was collected as well as information on subject experiences with illness and death. Twenty-six of the 160 participants (16%) had completed ADs. The prevalence of completion differed among the three clinics: HIV Clinic 25%, Oncology Clinic 18%, and GIM Clinic 8%. Nearly all patients (95%) expressed interest in ADs. Those not interested in ADs were more likely than those who were interested or those who had already completed ADs to have been in an intensive care unit themselves. Multiple barriers to completing ADs were identified. Advance directives are still used by relatively few people despite a general openness and interest in them. Few characteristics, demographic and otherwise, were identified to distinguish those who completed ADs from those who did not.
预先指示（ADs）是患者向其医生和家人传达的关于在其无法表达意愿时对医疗护理的期望的指示。本研究旨在描述已完成预先指示的成年人以及对其表示感兴趣的成年人的特征，并确定这些群体与对预先指示不感兴趣的群体之间的区别。另一个目标是就完成预先指示的障碍对研究人群进行调查。从三个诊所（普通内科诊所（GIM）、艾滋病毒诊所和肿瘤诊所）之一就诊的160名门诊患者中随机抽取样本进行研究。发放了一份包含10个项目的问卷，其中包括关于对预先指示的熟悉程度、信息来源以及兴趣的问题。收集了人口统计学信息以及关于受试者疾病和死亡经历的信息。160名参与者中有26人（16%）完成了预先指示。三个诊所的完成率有所不同：艾滋病毒诊所为25%，肿瘤诊所为18%，普通内科诊所为8%。几乎所有患者（95%）都表示对预先指示感兴趣。对预先指示不感兴趣的人比那些感兴趣或已经完成预先指示的人更有可能自己曾入住重症监护病房。确定了完成预先指示的多个障碍。尽管人们普遍对预先指示持开放态度并感兴趣，但使用预先指示的人仍然相对较少。几乎没有发现人口统计学或其他方面的特征来区分完成预先指示的人和未完成的人。
