Griffith C H, Wilson J F, Emmett K R, Ramsbottom-Lucier M, Rich E C
Department of Internal Medicine, University of Kentucky, Lexington, USA.
Arch Fam Med. 1995 Sep;4(9):780-4. doi: 10.1001/archfami.4.9.780.
Previous studies suggest that 20% to 67% of patients would desire cardiopulmonary resuscitation (CPR) even if they had advanced Alzheimer's disease. These preferences were not affected by education about CPR. We hypothesized that CPR preferences in scenarios involving Alzheimer's disease are influenced more by knowledge of or experience with Alzheimer's disease than by knowledge of CPR and its outcomes.
We performed a random digit-dialing telephone survey of adult Kentuckians in June 1993. A total of 661 persons responded. We asked respondents whether they have had a friend or family member with Alzheimer's disease and whether they had cared for that person at home. We then assessed basic knowledge of Alzheimer's disease and CPR. We read to one half of respondents an educational paragraph describing CPR and its outcomes. Finally, we asked respondents their CPR preference if they were to develop Alzheimer's disease.
Overall, 22% of respondents would probably or definitely want CPR if they had Alzheimer's disease. With the use of simultaneous multiple linear regression, predictors of refusing CPR in scenarios involving Alzheimer's disease included knowledge of or experience with Alzheimer's disease (P < .001), older age (P < .001), greater income (P < .004), female sex (P < .01), and nonwhite race (P < .04). Baseline knowledge of CPR did not affect CPR preferences, nor did being read the educational paragraph.
Cardiopulmonary resuscitation preferences in scenarios involving Alzheimer's disease are strongly associated with knowledge of or experience with Alzheimer's disease more so than with knowledge of CPR. These findings suggest that in eliciting patients' CPR preferences in an advanced directive, care must be taken that patients understand the condition presented in the scenario (eg, Alzheimer's disease).
先前的研究表明，即便患有晚期阿尔茨海默病，20%至67%的患者仍希望接受心肺复苏（CPR）。这些偏好不受关于CPR教育的影响。我们推测，在涉及阿尔茨海默病的情景中，CPR偏好更多地受阿尔茨海默病知识或经验的影响，而非CPR知识及其结果的影响。
1993年6月，我们对肯塔基州成年人进行了随机数字拨号电话调查。共有661人回应。我们询问受访者是否有患阿尔茨海默病的朋友或家庭成员，以及他们是否在家照顾过此人。然后我们评估了阿尔茨海默病和CPR的基本知识。我们向一半的受访者宣读了一段描述CPR及其结果的教育段落。最后，我们询问受访者如果他们患上阿尔茨海默病，他们对CPR的偏好。
总体而言，如果患有阿尔茨海默病，22%的受访者可能或肯定希望接受CPR。通过同时进行多元线性回归分析，在涉及阿尔茨海默病的情景中拒绝CPR的预测因素包括阿尔茨海默病知识或经验（P <.001）、年龄较大（P <.001）、收入较高（P <.004）、女性（P <.01）和非白人种族（P <.04）。CPR的基线知识不影响CPR偏好，宣读教育段落也不影响。
在涉及阿尔茨海默病的情景中，心肺复苏偏好与阿尔茨海默病知识或经验密切相关，而非与CPR知识相关。这些发现表明，在预先指示中引出患者的CPR偏好时，必须注意确保患者理解情景中呈现的病情（如阿尔茨海默病）。
