Micromanaging death: Process preferences, values, and goals in end-of-life medical decision making
Micromanaging death: Process preferences, values, and goals in end-of-life medical decision making
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DOI：
10.1093/geront/45.1.107
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发表时间：
2005-02-01
期刊：
影响因子：
5.7
通讯作者：
Smucker, WD
中科院分区：
文献类型：
--
作者：
Hawkins, NA;Ditto, PH;Smucker, WD
目的：本研究探讨病患与代理人对于使用预嘱来管理临终医疗照护的态度。它还探讨了过程偏好，或患者希望如何做出决定。设计和方法：数据来自第三波的预先指示，价值评估和沟通增强项目，一项纵向研究，旨在调查使用预先指示的心理假设。337名65岁以上的门诊患者及其指定的代理决策者完成了访谈和问卷调查。结果如下：很少有人愿意记录具体的医疗偏好，并要求无一例外地在临近死亡时遵循这些偏好。大多数人希望表达更一般的偏好，如护理的价值观和目标，除了（或，而不是）具体的治疗偏好，并允许代理决策者在决策中的回旋余地。患者与患者之间的变异性方面的过程偏好是巨大的，是代理人的误解患者的过程偏好。含义：很少有人会希望采用标准的方法来推进护理计划，即记录对特定生命维持治疗的偏好，并在临近死亡时严格遵循这些要求。相反，通过强调对过程偏好和决策余地的讨论，患者的自主权可能会得到更好的服务。
Purpose: This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a longitudinal study designed to investigate psychological assumptions underlying the use of advance directives. Three-hundred thirty-seven outpatients aged 65 and older and their designated surrogate decision makers completed interviews and questionnaires. Results: Very few individuals wished to document specific medical treatment preferences and mandate that they be followed, without exception, near death. Most desired to express more general preferences, such as values and goals for care, in addition to (or, instead of) specific treatment preferences and to allow surrogate decision makers leeway in decision making. Patient-to-patient variability with regard to process preferences was substantial, as was surrogates' misunderstanding of the patients' process preferences. Implications: Very few individuals may desire the standard approach to advance care planning whereby preferences for specific life-sustaining treatments are documented and these requests are strictly followed near death. Instead, patient autonomy may be better served by emphasizing discussion of process preferences and leeway in decision making.