Advance directives as acts of communication -: A randomized controlled trial
Advance directives as acts of communication -: A randomized controlled trial
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DOI：
10.1001/archinte.161.3.421
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发表时间：
2001-02-12
影响因子：
--
通讯作者：
Zyzanski, S
中科院分区：
文献类型：
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作者：
Ditto, PH;Danks, JH;Zyzanski, S
背景资料：指导性预先指令被广泛提倡作为一种手段，以保持病人的自决权，在生命的最后，基于这样的假设，他们提高代理人的理解病人的生命维持治疗的愿望。然而，没有研究已经检查是否教学指令是有效的，在提高准确性的替代decisions.Participants和方法：共401门诊患者年龄在65岁或以上，他们的自我指定的代理决策者（62%的配偶，29%的儿童）被随机分配到1的5个实验条件。在控制条件下，代理人预测患者的偏好4维持生命的药物治疗在9种疾病的情况下，没有病人完成的预先指示的好处。在这种情况下的准确性进行了比较，在4个干预条件下，代理人作出预测后，审查无论是基于神经网络或基于价值的指令完成的患者，无论是讨论或不讨论的内容与患者的指令。提前指令完成的感知效益也measured.Results：没有干预措施产生显着改善的准确性替代判断在任何疾病的情况下，或任何医疗。讨论干预措施提高了感知代理人的理解和舒适度的患者，代理人对患者没有完成一个预先指示研究participation.Conclusions：我们的研究结果挑战目前的政策和法律倡导教学预先指示的一种手段，尊重特定的病人的愿望，在生命的尽头。未来的研究应探索其他方法，提高代理决策，并考虑其他结果的价值，在评估提前护理计划的有效性。
Background: Instructional advance directives are widely advocated as a means of preserving patient self-determination at the end of life based on the assumption that they improve surrogates' understanding of patients' life-sustaining treatment wishes. However, no research has examined whether instructional directives are effective in improving the accuracy of surrogate decisions.Participants and Methods: A total of 401 outpatients aged 65 years or older and their self-designated surrogate decision makers (62% spouses, 29% children) were randomized to 1 of 5 experimental conditions. In the control condition, surrogates predicted patients' preferences for 4 life-sustaining medical treatments in 9 illness scenarios without the benefit of a patient-completed advance directive. Accuracy in this condition was compared with that in 4 intervention conditions in which surrogates made predictions after reviewing either a scenario-based or a value-based directive completed by the patient and either discussing or not discussing the contents of the directive with the patient. Perceived benefits of advance directive completion were also measured.Results: None of the interventions produced significant improvements in the accuracy of surrogate substituted judgment in any illness scenario or for any medical treatment. Discussion interventions improved perceived surrogate understanding and comfort for patient-surrogate pairs in which the patient had not completed an advance directive prior to study participation.Conclusions: Our results challenge current policy and law advocating instructional advance directives as a means of honoring specific patient wishes at the end of life. Future research should explore other methods of improving surrogate decision making and consider the value of other outcomes in evaluating the effectiveness of advance care planning.