Frequency and determinants of advance directives concerning end-of-life care in The Netherlands
Frequency and determinants of advance directives concerning end-of-life care in The Netherlands
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DOI：
10.1016/j.socscimed.2005.08.010
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发表时间：
2006-03-01
影响因子：
5.4
通讯作者：
Deeg, DJH
中科院分区：
文献类型：
--
作者：
Rurup, ML;Onwuteaka-Philipsen, BD;Deeg, DJH
在美国，人们对预先指令(ADS)的使用进行了广泛的研究，以确定增加其使用的机会。我们在荷兰调查了ADS的患病率和与AD形成相关的因素，使用了三组样本：60岁以下的普通人群，60岁以上的普通人群，以及在安乐死或协助自杀后死亡的患者的亲属。相关因素分为三个部分：诱因(如年龄、性别)、促成因素(如教育)和需要因素(如与健康有关的因素)。我们发现，3%的年轻人、10%的老年人和23%的安乐死或协助自杀后死亡的人的亲属制定了生前遗嘱。大多数生前遗嘱都涉及安乐死的请求。在所有群体中，26%-29%的人曾授权某人在他们不再能够自己做决定的情况下做出决定。与医生谈论临终治疗的频率较低，只有2%的年轻人和7%的老年人这样做过。大多数人都很有信心医生会尊重他们的临终遗愿，但老年人比年轻人更有信心。在多变量分析中，许多易感因素与AD的制定有关：妇女、老年人、非宗教人士，特别是生活在城市化地区的人，以及不太相信医生会尊重他们的临终遗愿的人更有可能制定AD。此外，较高教育水平的促成因素、在过去6个月内接触医学专家的需要因素以及婚姻伴侣的死亡与AD的形成有关。(C)2005爱思唯尔有限公司。保留所有权利。
In the USA, the use of advance directives (ADs) has been studied extensively, in order to identify opportunities to increase their use. We investigated the prevalence of ADs and the factors associated with formulation of an AD in The Netherlands, using samples of three groups: the general population up to 60 years of age, the general population over 60 years of age, and the relatives of patients who died after euthanasia or assisted suicide. The associated factors were grouped into three components: predisposing factors (e.g. age, gender), enabling factors (e.g. education) and need factors (e.g. health-related factors). We found that living wills had been formulated by 3% of younger people, 10% of older people, and 23% of the relatives of a person who died after euthanasia or assisted suicide. Most living wills concerned a request for euthanasia. In all groups, 26-29% had authorized someone to make decisions if they were no longer able to do so themselves. Talking to a physician about medical end-of-life treatment occurred less frequently, only 2% of the younger people and 7% of the older people had done so. Most people were quite confident that the physician would respect their end-of-life wishes, but older people more so than younger people. In a multivariate analysis, many predisposing factors were associated with the formulation of an AD: women, older people, non-religious people, especially those who lived in an urbanized area, and people with less confidence that the physician would respect their end-of-life wishes were more likely to have formulated an AD. Furthermore, the enabling factor of a higher level of education, the need factor of contact with a medical specialist in the past 6 months, and the death of a marital partner were associated with the formulation of an AD. (c) 2005 Elsevier Ltd. All rights reserved.