Silverman H J, Tuma P, Schaeffer M H, Singh B
Department of Medicine, University of Maryland School of Medicine, Baltimore.
Arch Intern Med. 1995 Mar 13;155(5):502-10.
The Patient Self-Determination Act aims to enhance patient awareness of advance directives by requiring health-care institutions to ask patients whether they have advance directives and to inform patients of their rights to prepare these documents. We investigated the following: (1) compliance of the hospital staff with implementing this act, (2) the effects of this act on the extent to which patients discuss and prepare advance directives, and (3) variables that might influence patient discussions on advance planning and preparation of advance directives.
We surveyed 219 patients from a university hospital that implemented a nurse-dependent advance directive program. We also conducted a telephone interview with 57% of these patients at least 6 months after hospital discharge.
Nurses asked 70% of the patients about the existence of an advance directive and of these patients, only 57% remembered the inquiry. Only 57% of the patients received the brochure on advance directives and of these patients, only 55% read the brochure. Only 2% of the patients requested to receive additional information on advance directives. Less than one quarter of the patients had discussions on advance planning while in the hospital and of those patients who were contacted within 6 months after hospital discharge, 39% had discussions on advance planning and 15% prepared an advance directive. Race was an independent predictor for hospital discussions, and educational level was an independent predictor for discussions and preparation of advance directives after hospital discharge.
To enhance the effectiveness of a nurse-dependent advance directive program, hospitals may need (1) to strengthen the quality of the patient-nurse encounter in which the issue of advance directives is raised to more effectively promote patient interest, discussions, and preparation of advance directives and (2) to account for the social diversity of their patient population.
《患者自我决定权法案》旨在通过要求医疗机构询问患者是否有预先指示，并告知患者准备这些文件的权利，来提高患者对预先指示的认识。我们调查了以下内容：（1）医院工作人员对该法案的执行情况；（2）该法案对患者讨论和准备预先指示程度的影响；（3）可能影响患者关于预先规划讨论和预先指示准备的变量。
我们对一家实施护士主导的预先指示项目的大学医院的219名患者进行了调查。我们还在患者出院至少6个月后对其中57%的患者进行了电话访谈。
护士询问了70%的患者是否存在预先指示，而在这些患者中，只有57%记得被询问过。只有57%的患者收到了关于预先指示的宣传册，在这些患者中，只有55%阅读了宣传册。只有2%的患者要求获得关于预先指示的更多信息。不到四分之一的患者在住院期间进行了关于预先规划的讨论，在出院后6个月内被联系的患者中，39%进行了关于预先规划的讨论，15%准备了预先指示。种族是住院期间讨论的独立预测因素，教育水平是出院后讨论和准备预先指示的独立预测因素。
为提高护士主导的预先指示项目的有效性，医院可能需要：（1）加强提出预先指示问题时的护患交流质量，以更有效地促进患者对预先指示的兴趣、讨论和准备；（2）考虑患者群体的社会多样性。
