Perspectives on advance directives in Japanese society: A population-based questionnaire survey.
Perspectives on advance directives in Japanese society: A population-based questionnaire survey.
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DOI：
10.1186/1472-6939-4-5
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发表时间：
2003-10-31
影响因子：
2.7
通讯作者：
Kai I
中科院分区：
文献类型：
--
作者：
Akabayashi A;Slingsby BT;Kai I
在日本，关于预先指示（ADs）的讨论在过去十年中一直在增加。ADs是提出的一种方法，旨在促进患者、家属和卫生保健提供者之间就不再有沟通能力的患者的护理计划进行沟通的过程。在本文中，我们报告了第一次对日本普通人群关于ADs偏好和使用的深入调查的结果。一份自我管理的问卷通过邮件发送给日本东京一个地区的560名居民（n = 165,567）进行分层随机抽样。使用联列表双变量分析和多元回归模型评估相关因素与ad特异性偏好之间的关联，以估计独立贡献。在发出的560份问卷中，共有425人参与调查，回应率为75.9%。本研究结果表明：1)最重要的组成部分是在生命末期阶段的医疗细节和诊断和预后的披露；2)大多数参与者认为通过口头方式向家人和/或医生表达他们的指示是合适的，而不是通过书面文件；（三）设立AD不需要采取法律措施的；4)允许家人和医生对病人的指示作出不严谨的解释；最合适的代理人被认为是家庭成员、亲戚或配偶。多变量分析发现，以下五个因素与偏好显著相关：1)对生前遗嘱的认识，2)使用ADs的经验，3)对临终治疗的偏好，4)对信息披露的偏好，以及5)创建遗嘱的意图。书面广告在日本的情况下可能是有用的，当个人希望：1)不给代理人和/或照顾者提供太多的余地，和/或2)在绝症、脑死亡和疼痛治疗的情况下确保他或她的指示，以及关于信息披露。
In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. A self-administered questionnaire was sent via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure.