Morrison R S, Zayas L H, Mulvihill M, Baskin S A, Meier D E
Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, New York, NY 10029, USA.
Arch Intern Med. 1998;158(22):2493-7. doi: 10.1001/archinte.158.22.2493.
Advance directives have not been uniformly used by different segments of the US population and studies have consistently shown a lower prevalence of advance directives among African Americans and Hispanics compared with non-Hispanic whites.
To examine barriers to completion of health care proxies for different ethnic groups.
One hundred ninety-seven subjects aged 65 years or older self-identified as African American (n = 65), Hispanic (n = 65), or non-Hispanic white (n = 67) attending a geriatrics and internal medicine outpatient clinic of a large New York City teaching hospital were administered a questionnaire. Questionnaires were developed to examine potential barriers to completion of health care proxies. Barriers were drawn from the literature and from focus groups.
Significant predictors of proxy completion using logistic regression analysis included knowledge of health care proxies, availability of a health care agent, exposure to mechanical ventilation, age, and self-reported health status as fair to poor. Subjects who believed that a health care agent was irrelevant in the setting of involved family were significantly less likely to have completed a health care proxy. Although there were significant differences in the baseline completion rates of health care proxies for the 3 ethnic groups, ethnicity did not predict prior appointment of a health care agent in multivariate analysis.
Differences in health care proxy completion rates across white, African American, and Hispanic elderly individuals in this New York City population seem to be related to potentially reversible barriers such as lack of knowledge and the perceived irrelevance of advance directives in the setting of involved family. Enhanced educational efforts of both health care personnel and patients could increase the rate of formal health care proxy appointment.
美国不同人群对预立医疗指示的使用并不统一，研究一直表明，与非西班牙裔白人相比，非裔美国人和西班牙裔人群中预立医疗指示的普及率较低。
研究不同种族人群完成医疗保健代理人指定的障碍。
对197名年龄在65岁及以上、自我认定为非裔美国人（n = 65）、西班牙裔（n = 65）或非西班牙裔白人（n = 67）的受试者进行问卷调查，这些受试者在纽约市一家大型教学医院的老年病科和内科门诊就诊。问卷旨在研究完成医疗保健代理人指定的潜在障碍。障碍来源于文献和焦点小组。
使用逻辑回归分析得出，医疗保健代理人指定完成情况的显著预测因素包括对医疗保健代理人的了解、有医疗保健代理人可供选择、曾接受机械通气、年龄以及自我报告的健康状况为一般至较差。认为在家庭参与的情况下医疗保健代理人无关紧要的受试者完成医疗保健代理人指定的可能性显著降低。尽管这三个种族群体的医疗保健代理人指定的基线完成率存在显著差异，但在多变量分析中，种族并不能预测之前是否指定了医疗保健代理人。
在纽约市的人群中，白人、非裔美国人和西班牙裔老年人在医疗保健代理人指定完成率上的差异似乎与一些可能可逆的障碍有关，比如缺乏了解以及在家庭参与的情况下认为预立医疗指示无关紧要。加强医护人员和患者的教育工作可能会提高正式指定医疗保健代理人的比例。
