Death and end-of-life planning in one midwestern community
Death and end-of-life planning in one midwestern community
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DOI：
10.1001/archinte.158.4.383
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发表时间：
1998-02-23
影响因子：
--
通讯作者：
Rooney, BL
中科院分区：
文献类型：
--
作者：
Hammes, BJ;Rooney, BL
背景：在本研究之前大约 2 年，某个地理区域的主要医疗保健组织实施了广泛的协作性预先指导教育计划。 目标：确定某个地理区域人群临终计划的流行程度和类型，以及所有当地医疗保健组织（包括医院、诊所、长期护理机构、家庭保健机构、临终关怀中心和县卫生机构）临终计划与决策之间的关系 方法：对居住在 5 个邮政编码范围内的所有成年死者的临终计划和决策进行了超过 11 个月的回顾性研究。这些死者在死亡前 10 年内具有精神能力，并在参与的医疗保健组织的护理下死亡。数据来自医疗记录和死亡证明。还联系了治疗医生和死者代理人进行访谈。结果：本研究共纳入了 540 名死者。书面预设医疗指示的普及率为 85%。几乎所有这些文件（95%）都在死者的病历中。提交预先医疗指示与死亡之间的中位时间为 1.2 年。几乎所有预先指示文件都要求在死亡临近时放弃治疗。 98% 的死亡患者放弃了治疗。在做出临终决定时，似乎始终遵循预先医疗指示中表达的治疗偏好。结论：这项研究提供了在存在广泛的预先医疗指导教育计划的地理区域中更完整的死亡、临终计划和决策的情况。它表明提前规划可能很普遍，并且可以有效指导临终决策。
Background: The major health care organizations in a geographically defined area implemented an extensive, collaborative advance directive education program approximately 2 years prior to this study.Objectives: To determine for a geographically defined population the prevalence and type of end-of-life planning and the relationship between end-of-life plans and decisions in all local health care organizations, including hospitals, medical clinics, long-term care facilities, home health agencies, hospices, and the county health department.Methods: For more than 11 months, end-of-life planning and decisions were retrospectively studied for all adult decedents residing in areas within 5 ZIP codes. These decedents were mentally capable in the 10 years prior to death and died while under the care of the participating health care organizations. Data were collected from medical records and death certificates. Treating physicians and decedent proxies were also contacted for interviews.Results: A total of 540 decedents were included in this study. The prevalence of written advance directives was 85%. Almost all these documents (95%) were in the decedent's medical record. The median time between advance directive documentation and death was 1.2 years. Almost all advance directive documents requested that treatment be forgone as death neared. Treatment was forgone in 98% of the deaths. Treatment preferences expressed in advance directives seemed to be consistently followed while making end-of-life decisions.Conclusions: This study provides a more complete picture of death, end-of-life planning, and decision making in a geographic area where an extensive advance directive education program exists. It indicates that advance planning can be prevalent and can effectively guide end-of-life decisions.