Voltz R, Akabayashi A, Reese C, Ohi G, Sass H M
Department of Neurology, Klinikum Grosshadern, University of Munich, Germany.
J Pain Symptom Manage. 1998 Sep;16(3):153-62. doi: 10.1016/s0885-3924(98)00067-0.
In order to explore possible differences in the scope of end-of-life decisions and attitudes toward advance directives (AD) in palliative care, we conducted a survey of 159 patients in palliative care institutions and 93 health-care professionals experienced in palliative care in the United States, Germany, and Japan. Giving an AD in this clinical setting was considered important by patients and professionals. The prevalence of a formal written AD was 79% in the United States, 18% in Germany, and 9% in Japan. In Japan, there was a high prevalence of entrusting all decisions to the family (known as omakase). More than 80% of the patients had negative feelings toward their future decisions in the United States and Germany, in contrast to only 45% in Japan. Although favored by the professionals, there were no specific instruments for obtaining ADs. In Germany and Japan, some patients had given an informal AD. As a pilot content validity step, survey results were used to derive a checklist for content and procedural aspects in end-of-life decision-making. This checklist may provide the basis for developing an instrument to guide physicians, especially non-palliative care specialists, in communication with their patients and their families in this difficult clinical situation.
为了探究临终决策范围以及对姑息治疗中预先指示（AD）态度的可能差异，我们对美国、德国和日本的159名姑息治疗机构患者以及93名有姑息治疗经验的医疗保健专业人员进行了一项调查。在这种临床环境下给予预先指示被患者和专业人员视为重要事项。正式书面预先指示的普及率在美国为79%，在德国为18%，在日本为9%。在日本，将所有决策委托给家人（即“お任せ”）的情况很普遍。在美国和德国，超过80%的患者对自己未来的决策有负面情绪，相比之下，日本只有45%。尽管受到专业人员的青睐，但没有获取预先指示的特定工具。在德国和日本，一些患者给出了非正式的预先指示。作为内容效度的初步步骤，调查结果被用于得出一份临终决策内容和程序方面的清单。这份清单可能为开发一种工具提供基础，以指导医生，尤其是非姑息治疗专科医生，在这种困难的临床情况下与患者及其家人进行沟通。
