High rates of advance care planning in New York City's elderly population
High rates of advance care planning in New York City's elderly population
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DOI：
10.1001/archinte.164.22.2421
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发表时间：
2004-12-13
影响因子：
--
通讯作者：
Meier, DE
中科院分区：
文献类型：
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作者：
Morrison, RS;Meier, DE
背景资料：以前的研究已经证明了提前护理计划（ACP）的低比率，特别是在非白人人群中，提出了关于这种决策过程的普遍性的问题。目的：探讨可能影响患者参与ACP意愿的因素。设计：调查。设置：随机选择的34个纽约市老年中心。参与者：共有700名非裔美国人（n = 239），西班牙裔（n = 23 7）和白色（n = 224）60岁及以上的成年人。干预：参与者进行了一项51项调查，评估了对ACP的态度、信念和实践。主要结果测量：态度和信念的医生的可信度，宿命论，信仰代理决策，舒适的讨论结束了生命的医疗care.Results：超过三分之一的参与者已经完成了医疗保健代理完成率;与医疗保健代理完成相关的因素。3个族裔群体的完成率没有显著差异。有初级保健医生的受访者（比值比[OR]，2.0; 95%置信区间[CI]，1.3-3.2），对预先指令的了解更多（OR，2.0; 95% CI，1.4-2.9），或曾见过朋友或家人使用机械呼吸机（OR，1.5; 95% CI，1.02-2.1）更有可能指定医疗保健代理人。受访者谁是唯一舒适的讨论ACP，如果讨论是由医生（OR，0.6; 95%CI，0.0-0.8）发起的显着不太可能已经完成了一个医疗proxy.Conclusions：非裔美国人，西班牙裔，和白色社区居住，老年人有同样高的提前指令完成率。预先指导完成的主要预测因素涉及可修改的因素，如已建立的初级保健医生，机械通气的个人经验，对ACP过程的了解，以及医生是否愿意有效地发起此类讨论。一些种族/民族的差异，在本研究中观察到的集体家庭为基础的决策的愿望有影响的演变，非加太国家的政策，尊重和操作这些偏好。
Background: Previous studies have demonstrated low rates of advance care planning (ACP), particularly among nonwhite populations, raising questions about the generalizability of this decision-making process.Objective: To explore factors that may influence patients' willingness to engage in ACP.Design: Survey.Setting: Thirty-four randomly selected New York City senior centers.Participants: A total of 700 African American (n = 239), Hispanic (n = 23 7), and white (n = 224) adults 60 years and older.Intervention: Participants were administered a 51-item survey that assessed attitudes, beliefs, and practices regarding ACP.Main Outcome Measures: Attitudes and beliefs about physicians' trustworthiness, fatalism, beliefs about surrogate decision making, and comfort discussing end-of-life medical care; factors associated with health care proxy completion; and health care proxy completion rates.Results: More than one third of the participants had completed a health care proxy. There were no significant differences in completion rates across the 3 ethnic groups. Respondents who had a primary care physician (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-3.2), were more knowledgeable about advance directives (OR, 2.0; 95% CI, 1.4-2.9), or had seen a friend or family member use a mechanical ventilator (OR, 1.5; 95% CI, 1.02-2.1) were significantly more likely to have designated a health care proxy. Respondents who were only comfortable discussing ACP if the discussion was initiated by the physician (OR, 0.6; 95% CI, 0.0-0.8) were significantly less likely to have completed a health care proxy.Conclusions: African American, Hispanic, and white community-dwelling, older adults had similarly high rates of advance directive completion. The primary predictors of advance directive completion involved modifiable factors such as established primary care physicians, personal experience with mechanical ventilation, knowledge about the process of ACP, and physicians' willingness to effectively initiate such discussions. Some of the racial/ethnic differences in desire for collective family-based decision making that were observed in this study have implications for the evolution of ACP policy that respects and operationalizes these preferences.