Glick K L, Mackay K M, Balasingam S, Dolan K R, Casper-Isaac S
Rochester General Hospital, USA.
J N Y State Nurses Assoc. 1998 Mar;29(1):4-8.
The concept of advance directives, although sound in theory, appears to be failing to meet the needs of many patients. Advance directives have been endorsed by both the healthcare profession and the general public, yet few individuals have documented their wishes for treatment preferences in end-of-life decisions. A review of 15 research articles revealed three main barriers to the completion and effective use of advance directives. These barriers are: (a) lack of education or knowledge regarding advance directives, (b) difficulties with paperwork completion, and (c) discordance between patient, family members or proxy, and provider. Future research is suggested to generate information that will facilitate meeting the needs of patients and their families in this most difficult aspect of healthcare delivery.
预先指示的概念虽然在理论上是合理的，但似乎未能满足许多患者的需求。预先指示已得到医疗行业和公众的认可，但很少有人记录他们在临终决策中对治疗偏好的意愿。对15篇研究文章的综述揭示了预先指示的制定和有效使用的三个主要障碍。这些障碍是：(a) 缺乏关于预先指示的教育或知识，(b) 填写文书工作困难，以及(c) 患者、家庭成员或代理人与提供者之间的不一致。建议未来的研究生成信息，以促进在医疗服务这一最困难的方面满足患者及其家人的需求。
