Associated factors for discussing advance directives with family physicians by noncancer outpatients in Japan
Associated factors for discussing advance directives with family physicians by noncancer outpatients in Japan
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日本非癌症门诊患者与家庭医生讨论预先医疗指示的相关因素
DOI：
10.1002/jgf2.238
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发表时间：
2019
影响因子：
1.6
通讯作者：
Maeno Tetsuhiro
中科院分区：
文献类型：
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作者：
Hamada Shuhei;Haruta Junji;Hamano Jun;Maeno Takami;Maeno Tetsuhiro
背景初级保健医生 (PCP) 和患者之间很少讨论预先指示 (AD)，尤其是患有非癌症疾病的患者。目的是确定非癌症患者与其医生讨论 AD 相关的因素。方法这项横断面研究于 2017 年 10 月至 12 月在一家医院或诊所进行。医生选择了 20 岁或以上的符合条件的非癌症患者来回答一份匿名的自我完成问卷，询问客观变量“我想与我的医生讨论 AD”以及基本特征，以及 先前研究中确定的讨论 AD 的促进因素和障碍。医生们对一项包括姑息表现量表（PPS）的调查做出了回应，并询问了每位患者的疾病类别。数据采用二项logistic回归分析。结果共纳入270例患者（有效缓解率为79.6%）。多变量分析确定了研究地点的访问时间≥3年（比值比[OR]，2.07；95%置信区间[CI]，1.05‐4.10）、非常擅长照顾患者疾病的医生（OR，12.68；95% CI，1.12‐143.22）以及患者对未来生活质量（QOL）的担忧（或，2.69；95% CI，1.30‐5.57）是与医生讨论 AD 的促进因素，PPS ≤ 90（OR，0.51；95% CI，0.26‐0.98）是障碍。结论我们的研究表明，患者对未来生活质量的担忧、长期就诊以及身体症状的存在与非癌症患者与 PCP 讨论 AD 的意愿相关。
BackgroundAdvance directives (ADs) are seldom discussed between primary care physicians (PCPs) and their patients, especially those with noncancer diseases. The aim was to identify the factors associated with discussing AD by noncancer patients with their physicians.MethodsThis cross‐sectional study was conducted in a hospital or clinic from October to December 2017. Physicians chose eligible noncancer patients aged 20 years or older to respond to an anonymous self‐completed questionnaire inquiring about the objective variable “I want to discuss AD with my doctor,” as well as basic characteristics, and facilitators and barriers to discussing AD identified in previous studies. The physicians responded to a survey comprising the Palliative Performance Scale (PPS) and inquiring about the disease category for each patient. Data were analyzed using binomial logistic regression analysis.ResultsA total of 270 patients (valid response rate, 79.6%) were included. Multivariate analysis identified a period of visit to the study site ≥ 3 years (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05‐4.10), physicians who are very good at taking care of patients’ disease (OR, 12.68; 95% CI, 1.12‐143.22), and patients’ worry about their quality of life (QOL) in the future (OR, 2.69; 95% CI, 1.30‐5.57) as facilitators for discussing AD with physicians, and PPS ≤ 90 (OR, 0.51; 95% CI, 0.26‐0.98) as a barrier.ConclusionsOur study indicates that patients’ future QOL concerns, a long period of visit to a hospital, and the presence of physical symptoms were associated with the willingness of noncancer patients to discuss AD with PCPs.