Heffner J E, Fahy B, Barbieri C
Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85001, USA.
Chest. 1996 Feb;109(2):373-9. doi: 10.1378/chest.109.2.373.
We conducted a questionnaire survey of 346 pulmonary rehabilitation programs to determine the present utilization and potential value of these sites for promoting advance directive education for patients with chronic lung diseases. Responses were analyzed for all responding programs and for programs categorized by size. Eighty-two percent of the 218 responding programs discussed with patients prognostic information. Only 33% of programs asked patients if they had advance directives and 17% kept these documents on file. Thirty-three percent of programs provided some form of advance directive education, and 42% distributed directive educational material, usually through informal and unstructured methods. Seventy-seven percent of responders considered pulmonary rehabilitation an appropriate site for directive education, and 86% indicated willingness to incorporate directive education into their programs. Larger programs were more likely to present information about patient prognosis (p = 0.0003) and advance directives (p = 0.021). We conclude that most of the responding pulmonary rehabilitation programs do not educate patients about advance directives but are willing to do so if supplied with appropriate teaching materials. Rehabilitation programs may be valuable sites for educating patients with chronic disorders about advance directives and promoting an improved patient-physician dialogue about these issues.
我们对346个肺康复项目进行了问卷调查，以确定这些场所目前在促进慢性肺病患者预先医疗指示教育方面的利用情况和潜在价值。对所有回复项目以及按规模分类的项目的回复进行了分析。在218个回复项目中，82%与患者讨论了预后信息。只有33%的项目询问患者是否有预先医疗指示，17%将这些文件存档。33%的项目提供了某种形式的预先医疗指示教育，42%分发了指示教育材料，通常是通过非正式和无组织的方式。77%的回复者认为肺康复是进行指示教育的合适场所，86%表示愿意将指示教育纳入其项目。规模较大的项目更有可能提供有关患者预后的信息（p = 0.0003）和预先医疗指示（p = 0.021）。我们得出结论，大多数回复的肺康复项目没有对患者进行预先医疗指示教育，但如果提供适当的教学材料，他们愿意这样做。康复项目可能是教育慢性疾病患者预先医疗指示并促进就这些问题改善医患对话的重要场所。
