Sam M, Singer P A
Centre for Bioethics, University of Toronto, Ont.
CMAJ. 1993 May 1;148(9):1497-502.
To examine the knowledge of, previous experience with, attitudes toward and perceived barriers to completing advance directives among outpatients at two general medicine clinics.
Cross-sectional questionnaire administered in face-to-face structured interviews.
General internal-medicine outpatient clinics at a university teaching hospital.
One hundred and five adult outpatients who could communicate in spoken English and who consented to be interviewed.
Of 167 patients approached, 58 were excluded because they could not communicate in spoken English, and 4 refused to participate. Of the remaining 105 patients, 17 (16%) knew about living wills, 12 (11%) about durable powers of attorney for health care and 4 (4%) about advance directives. Twenty-three (22%) had thought about their preferences for life-sustaining treatment, 20 (19%) had discussed them, none had written them down, and 45 (43%) had thought about choosing a proxy. Sixty-one (58%) wanted to think about their preferences for treatment, 65 (62%) wanted to discuss them, 32 (30%) wanted to write them down, and 80 (76%) wanted to choose a proxy. The perceived barriers to completing an advance directive were inability to write, the belief that an advance directive was unnecessary, a fatalistic attitude, previous discussion of preferences, a desire to leave the decision to doctors, uncertainty about preferences, a desire to discuss preferences rather than document them, a desire to wait until the situation arose, a desire to write down preferences in the future and a desire to avoid thinking about preferences or advance directives. Respondents with more knowledge of life-sustaining treatments were more likely to want to complete an advance directive.
Outpatients have positive attitudes toward advance directives, but their knowledge and experience are limited. These data underscore the need for patient education and for policies to eliminate the barriers to completing advance directives that patients face.
调查两家普通内科门诊的门诊患者对预先指示的了解程度、既往经验、态度以及完成预先指示所感知到的障碍。
通过面对面结构化访谈进行横断面问卷调查。
一所大学教学医院的普通内科门诊。
105名能用英语口语交流且同意接受访谈的成年门诊患者。
在接触的167名患者中，58名因无法用英语口语交流被排除，4名拒绝参与。在其余105名患者中，17名（16%）了解生前遗嘱，12名（11%）了解医疗保健持久授权书，4名（4%）了解预先指示。23名（22%）曾思考过维持生命治疗的偏好，20名（19%）曾讨论过这些偏好，无人将其记录下来，45名（43%）曾考虑选择代理人。61名（58%）想要思考自己的治疗偏好，65名（62%）想要讨论这些偏好，32名（30%）想要记录下来，80名（76%）想要选择代理人。完成预先指示所感知到的障碍包括无法书写、认为预先指示不必要、宿命论态度、之前对偏好的讨论、希望将决定权留给医生、对偏好不确定、希望讨论偏好而非记录下来、希望等到情况出现、希望未来记录偏好以及希望避免思考偏好或预先指示。对维持生命治疗了解更多的受访者更有可能想要完成预先指示。
门诊患者对预先指示持积极态度，但他们的知识和经验有限。这些数据强调了患者教育以及消除患者完成预先指示所面临障碍的政策的必要性。
