Patients who complete advance directives and what they prefer
Patients who complete advance directives and what they prefer
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DOI：
10.4065/82.12.1480
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发表时间：
2007-12-01
影响因子：
8.9
通讯作者：
Crowley, Mary E.
中科院分区：
文献类型：
--
作者：
Nishimura, Adam;Mueller, Paul S.;Crowley, Mary E.
目的：确定患者提前指令(ADS)表达的医疗服务偏好，并确定完成ADS的患者的特征。方法和方法：从2004年1月1日至2005年7月1日期间向Mayo Clinic Rochester提交ADS的25,865名(误差率为+/-4.34%)的唯一患者中，随机抽取500名患者。排除24例(4.8%)未提交ADS的患者，分析476份ADS的内容和患者的人口学特征。结果：患者签署ADS时的年龄中位数为67岁(19-97岁)。在476名研究患者中，409名(91.3%)是高中毕业生；339名(71.2%)提交了具有生前遗嘱和医疗保健委托书特征的综合AD；434名(91.2%)指定了卫生保健代理人；大多数代理人授予代理人权力，同意进行程序(340[78.3%])，获取信息(327[75.3%])，以及停止和取消维持生命治疗(337[77.6%])。大多数患者表示希望控制疼痛(308例(64.7%))。对于临床情况：对于死亡或永久性昏迷，大多数患者明确表示倾向于避免“一般生命支持”(371例(77.9%))，但没有明确提到常见的生命维持治疗，包括心肺复苏、机械通气、血液透析、输血、人工营养和水合(如果他们这样做了，几乎所有患者都表示倾向于避免治疗)。结论：在提交给本研究所的ADS中，大多数患者指定了保健代理人，并赋予该代理人广泛的决策权。尽管大多数人表示希望在死亡或永久昏迷时避免“一般的生命维持”，但很少有人表示倾向于具体的维持生命的治疗。使用ADS的患者、临床医生和其他人，以及考虑涉及ADS的研究的调查人员，可能会发现这些结果提供了信息。
OBJECTIVE: To determine health care preferences expressed by patients in advance directives (ADs) and to Identify characteristics of patients who completed them.PATIENTS AND METHODS: A computer-generated random sample of 500 patients was selected from the 25,865 (margin of error, +/- 4.34%) unique patients who submitted ADs to Mayo Clinic Rochester between January 1, 2004, and July 1, 2005. After excluding 24 (4.8%) patients who had submitted documents related to financial and property matters instead of ADs, we analyzed the contents of the 476 ADs and the demographic features of the patients to whom the documents belonged.RESULTS: The median (range) age of the patients at the time they signed their respective ADs was 67 (19-97) years. Of the 476 study patients, 409 (91.3%) were high school graduates; 339 (71.2%) had submitted a combined AD, which has features of a living will and a health care power of attorney; 434 (91.2%) had designated a health care agent; and most had granted the agent powers to consent for procedures (340 [78.3%]), to access information (327 [75.3%]), and to withhold and withdraw life-sustaining treatments (337 [77.6%]). Most patients expressed desire for pain control (308 [64.7%]). For the clinical situation: of dying or permanent unconsciousness, most patients explicitly expressed a preference to avoid "general life support" (371 [77.9%]) but did not explicitly address common life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, blood transfusion, and artificial nutrition and hydration (if they did, nearly all expressed a preference to avoid the treatments).CONCLUSION: In ADs submitted to our Institution, most patients designated a health care agent and granted the agent broad decision-making powers. Although most expressed a desire to avoid "general life support" if dying or permanently unconscious, few expressed preferences regarding specific life-sustaining treatments. Patients, clinicians, and others who use ADs, and investigators contemplating research involving ADs, might find these results informative.