Elpern E H, Yellen S B, Burton L A
Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.
Am J Crit Care. 1993 Mar;2(2):161-7.
Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives.
A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991.
Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse.
Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.
预先指示是一种在临终决策中促进患者自主权的方式，但使用频率不高。最近的一项联邦法律要求医疗保健机构向患者提供有关预先指示的信息。本研究探讨了在三个方面与预先指示使用相关的态度和行为：对预先指示的熟悉程度、完成或未完成预先指示的原因以及接收有关预先指示信息的偏好。
1991年夏天，通过个人访谈对一家大型城市学术三级医疗中心的46名住院患者和50名门诊患者组成的非随机便利样本进行了问卷调查。
大多数受访者（77%）听说过生前遗嘱或医疗保健持久授权书，但只有52%的人正确理解了这些文件的目的。样本中有29%的人已签署预先指示。与没有预先指示的人相比，有预先指示的人年龄更大，且自认为健康状况较差。最常被提及的没有预先指示的原因是对预先指示不熟悉和拖延。大多数受试者（65%）曾与他人，通常是家庭成员或密友，谈论过在重病期间的治疗偏好。尽管他们很少讨论预先指示，但83%的人预计与医生或护士讨论时会感到自在。
预先指示很少被用于记录治疗偏好。促进更多使用预先指示的项目的成功取决于更清楚地了解影响签署预先指示的决策和行动的因素。患者声称在讨论这个话题时会感到自在，并且更喜欢在门诊环境中进行此类讨论。
