Eleazer G P, Hornung C A, Egbert C B, Egbert J R, Eng C, Hedgepeth J, McCann R, Strothers H, Sapir M, Wei M, Wilson M
University of South Carolina School of Medicine, Columbia, USA.
J Am Geriatr Soc. 1996 Aug;44(8):938-43. doi: 10.1111/j.1532-5415.1996.tb01864.x.
To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly).
Retrospective chart review of 1193 participants in the PACE program.
Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.
A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non-Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians.
Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy.
Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non-Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives.
In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development.
评估民族与医疗保健意愿（包括预立医疗指示）之间的关系，研究对象为一组参加“老年人全包式护理计划”（PACE）的体弱老年人。
对PACE项目的1193名参与者进行回顾性病历审查。
老年人全包式护理计划（PACE），这是一个综合性管理式护理示范项目，在全国10个地点为体弱的老年参与者提供服务。
共有1193名老年人，他们均符合养老院护理水平的州标准。其中有385名非西班牙裔白人、364名黑人、156名西班牙裔和288名亚洲人。
是否存在预立医疗指示，所选择的医疗保健意愿类型，包括生存意愿、持久授权书和医疗保健代理人。
体弱的老年白人、黑人、西班牙裔和亚裔美国人在医疗保健意愿以及表达意愿的方式上存在显著差异。黑人选择积极干预措施的可能性显著更高，且与非西班牙裔白人和西班牙裔相比，使用书面文书表达医疗保健意愿的可能性更低。白人使用书面文件作为预立医疗指示的可能性显著更高，而亚洲人更倾向于选择不太积极的干预措施，但不太可能使用书面预立医疗指示。
在这一人群中，我们发现医疗保健意愿的选择存在显著的种族差异。尽管医疗保健意愿是个人决定，但了解跨文化模式有助于从业者解决患者的担忧，也有助于医疗保健政策的制定。
