Advance Directive Discussions: Lost in Translation or Lost Opportunities?
Advance Directive Discussions: Lost in Translation or Lost Opportunities?
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DOI：
10.1089/jpm.2011.0328
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发表时间：
2012-01-01
影响因子：
2.8
通讯作者：
Kutner, Jean
中科院分区：
文献类型：
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作者：
Fischer, Stacy M.;Sauaia, Angela;Kutner, Jean
背景资料：以前的研究表明，少数民族人口有记录的预先指令的比例较低，并表示更喜欢在生命结束时延长生命的干预措施。我们试图确定拉丁裔种族对患者自我报告的影响，即在严重医疗疾病的索引住院治疗中进行预先指导讨论和在病历中完成预先指导。方法：这是一项前瞻性观察性队列研究，纳入了458名在一家安全网医院（一家学术医疗中心）的综合医疗服务机构住院的成年人，退伍军人事务部（VA）医院。患者被问及他们是否讨论了预先指示，我们审查了医疗记录的预先指示。结果：总的来说，45%的患者报告说他们讨论过预先指示。（29%的拉丁美洲人和54%的高加索人，p = 0.0002），24%的患者在其病历中有完整的预先指示（25%的拉丁裔和26%的白人，p =不显著[ns]）。使用逻辑回归模型并调整社会经济地位（SES），教育水平和语言，拉丁美洲人（比值比[OR] 0.42，置信区间[CI] 0.24-0.75）与高加索人（参考）相比，不太可能报告有预先指导的讨论。然而，在医疗记录中的一个完整的预先指令的建模没有显着差异拉丁美洲人（OR 1.44，CI 0.73-2.85）和高加索人（referent）.Conclusions：意想不到的差异，我们发现突出了需要更有效的沟通，提前护理规划，包括教育，文化上的敏感性和低健康素养的人。
Background: Previous studies have shown that minority populations have low rates of documented advance directives and express preferences for more life-prolonging interventions at the end of life. We sought to determine the impact of Latino ethnicity on patients' self-report of having an advance directive discussion and having a completed advance directive in the medical record at an index hospitalization for serious medical illness.Methods: This was a prospective observational cohort study of 458 adults admitted to the general medical services of a safety net hospital, an academic medical center, and a Veterans' Affairs (VA) hospital. Patients were asked if they had discussed advance directives, and we reviewed medical records for documented advance directives.Results: Overall, 45% of patients reported having had a discussion about advance directives (29% of Latinos compared with 54% of Caucasians, p = 0.0002) and 24% of patients had a completed advance directive in their medical record (25% Latinos and 26% of Caucasians, p =not significant [ns]). Using logistic regression modeling and adjusting for socioeconomic status (SES), education level, and language spoken, Latinos (odds ratio [OR] 0.42, confidence interval [CI] 0.24-0.75) were less likely to report having advance directive discussions compared with Caucasians (referent). However, modeling of a completed advance directive in the medical record showed no significant difference between Latinos (OR 1.44, CI 0.73-2.85) and Caucasians (referent).Conclusions: The unexpected discrepancy we found highlights the need for more effective communication in advance care planning that includes education that is culturally sensitive and accessible to persons with low health literacy.