Jacobson J A, Kasworm E, Battin M P, Francis L P, Green D, Botkin J, Johnson S
Department of Internal Medicine, LDS Hospital, Salt Lake City, USA.
Arch Intern Med. 1996 Sep 9;156(16):1862-8.
Advance directives have been studied in different patient populations and institutions. Most reports have shown limited use and little medically observable effect. To our knowledge, no previous study has focused on the use of advance directives by individuals who have died or how their family members perceived the documents' effect.
We contacted informants listed on Utah Death Certificates from 1992 to estimate the prevalence and effect of advance directives. Eighty-two percent of 1398 informants we contacted agreed to our telephone interview.
More than 50% of decedents reportedly completed an advance directive. Individuals older than 65 years (57.3%), women (58.1%), nursing home residents (63.4%), and hospice users (75.2%) were most likely to have had advance directives. Education, religion, religiosity, and location had no effect on prevalence. Most informants stated that advance directives had no effect on the decedent's care, but a minority felt they helped to limit treatment. Do-not-resuscitate orders were written more often for patients with advance directives. Feeding tubes were removed more often from decedents with living wills than from other decedents. Mechanical ventilatory support was not less frequent in patients with advance directives.
Our study confirms others that found little evidence that advance directives affect life-sustaining treatments. In the infrequent situations when they apply, they may be more persuasive than family members in convincing physicians to limit treatment. We observed that survivors had 2 perceptions about advance directives, not emphasized in previous reports, that they seemed to limit treatment and to ease their burden of decision making.
生前预嘱已在不同患者群体和机构中得到研究。大多数报告显示其使用有限，且几乎没有医学上可观察到的效果。据我们所知，此前没有研究关注过已故者生前预嘱的使用情况，或其家庭成员对这些文件效果的看法。
我们联系了1992年犹他州死亡证明上列出的信息提供者，以评估生前预嘱的普及率和效果。我们联系的1398名信息提供者中，82%同意接受我们的电话采访。
据报道，超过50%的死者完成了生前预嘱。65岁以上的人（57.3%）、女性（58.1%）、养老院居民（63.4%）和临终关怀使用者（75.2%）最有可能有生前预嘱。教育程度、宗教信仰、宗教虔诚度和地理位置对普及率没有影响。大多数信息提供者表示，生前预嘱对死者的护理没有影响，但少数人认为它们有助于限制治疗。对于有生前预嘱的患者，更多地开具了不要复苏的医嘱。与其他死者相比，有生前遗嘱的死者更常被拔除喂食管。有生前预嘱的患者接受机械通气支持的频率并不低。
我们的研究证实了其他研究的发现，即几乎没有证据表明生前预嘱会影响维持生命的治疗。在它们适用的罕见情况下，在说服医生限制治疗方面，它们可能比家庭成员更有说服力。我们观察到，幸存者对生前预嘱有两种看法，这在以前的报告中没有强调，即它们似乎限制了治疗，并减轻了他们的决策负担。
