Hammes B J, Rooney B L
Gundersen Lutheran Medical Center, La Crosse, Wisconsin, USA.
Arch Intern Med. 1998 Feb 23;158(4):383-90. doi: 10.1001/archinte.158.4.383.
The major health care organizations in a geographically defined area implemented an extensive, collaborative advance directive education program approximately 2 years prior to this study.
To determine for a geographically defined population the prevalence and type of end-of-life planning and the relationship between end-of-life plans and decisions in all local health care organizations, including hospitals, medical clinics, long-term care facilities, home health agencies, hospices, and the county health department.
For more than 11 months, end-of-life planning and decisions were retrospectively studied for all adult decedents residing in areas within 5 ZIP codes. These decedents were mentally capable in the 10 years prior to death and died while under the care of the participating health care organizations. Data were collected from medical records and death certificates. Treating physicians and decedent proxies were also contacted for interviews.
A total of 540 decedents were included in this study. The prevalence of written advance directives was 85%. Almost all these documents (95%) were in the decedent's medical record. The median time between advance directive documentation and death was 1.2 years. Almost all advance directive documents requested that treatment be forgone as death neared. Treatment was forgone in 98% of the deaths. Treatment preferences expressed in advance directives seemed to be consistently followed while making end-of-life decisions.
This study provides a more complete picture of death, end-of-life planning, and decision making in a geographic area where an extensive advance directive education program exists. It indicates that advance planning can be prevalent and can effectively guide end-of-life decisions.
在本研究开展约两年前，某地理区域内的主要医疗保健机构实施了一项广泛的、协作性的生前预嘱教育项目。
针对某地理区域内的人群，确定临终规划的患病率及类型，以及所有当地医疗保健机构（包括医院、诊所、长期护理机构、家庭健康机构、临终关怀机构及县卫生部门）中临终规划与决策之间的关系。
在超过11个月的时间里，对居住在5个邮政编码区域内的所有成年死者的临终规划与决策进行回顾性研究。这些死者在死亡前10年精神状态正常，且在参与研究的医疗保健机构的照料下死亡。数据从医疗记录和死亡证明中收集。还联系了主治医生和死者代理人进行访谈。
本研究共纳入540名死者。生前预嘱的普及率为85%。几乎所有这些文件（95%）都保存在死者的医疗记录中。生前预嘱记录与死亡之间的中位时间为1.2年。几乎所有生前预嘱文件都要求在临近死亡时放弃治疗。98%的死亡案例中放弃了治疗。在做出临终决策时，生前预嘱中表达的治疗偏好似乎得到了一致遵循。
本研究更全面地呈现了在存在广泛生前预嘱教育项目的地理区域内的死亡、临终规划及决策情况。这表明生前规划可能很普遍，并且可以有效地指导临终决策。
