Would they follow what has been laid down? Cancer patients' and healthy controls' views on adherence to advance directives compared to medical staff.
Would they follow what has been laid down? Cancer patients' and healthy controls' views on adherence to advance directives compared to medical staff.
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DOI：
10.1007/s11019-005-2108-8
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发表时间：
2005-01-01
期刊：
影响因子：
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通讯作者：
Hommel, G
中科院分区：
文献类型：
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作者：
Sahm, S;Will, R;Hommel, G
未标记：预先指示作为工具传播，以保持患者的自主权，以防他们不再能够自己决定。从未研究过患者和健康人本身是否倾向于遵守这些文件。患者和健康人的意见，是否应遵循预先指示，因为这是（或不是）“正确的事情要做”，而不是因为一个是法律上有义务这样做，进行了研究，并与医务人员相比。癌症患者，健康人，护理人员和医生（n = 100，每组）进行了采访。计算依从性评分（最大值5）。所有组的依从性评分均较低，但患者（1.55;标准差1.13）和健康对照组（1.60; 1.37）的依从性评分最低。护理人员与患者、健康对照组之间及医生与患者之间的差异均有显著性（P < 0.005和P <0.05）。受访者谁希望这些文件被遵循的倾向于独居，并已书面的预先指示。结论：癌症患者和健康人广泛忽视预先指示规定的指示，并认为他们比医生和护理人员没有那么有约束力。只有少数人倾向于更坚持预先指示。为了改善患者在生命结束时的决策，当患者不再能够自己决定时，应考虑替代概念，如先进的护理计划。
UNLABELLED: Advance directives are propagated as instruments to maintain patients' autonomy in case they can no longer decide for themselves. It has been never been examined whether patients' and healthy persons themselves are inclined to adhere to these documents. Patients' and healthy persons' views on whether instructions laid down in advance directives should be followed because that is (or is not) "the right thing to do", not because one is legally obliged to do so, were studied and compared with that of medical staff.METHOD: Vignette study presenting five cases. Cancer patients, healthy persons, nursing staff and physicians (n = 100 in each group) were interviewed. An adherence score was calculated (maximum value 5). The adherence score is found to be low in all groups, yet lowest in patients (1.55; standard deviation 1.13) and healthy controls (1.60; 1.37). The scores are significantly different between nursing staff on the one hand and patients and healthy controls on the other (p < 0.005 and p < 0.05, respectively), and between doctors and patients (p < 0.05). Interviewees who want these documents to be followed tend to live alone and to have already written an advance directive.CONCLUSIONS: Cancer patients and healthy persons widely disregard instructions laid down in advance directives and consider them less binding than physicians and nursing staff do. Only a minority tends to adhere more to advance directives. To improve decision-making at the end of life when patients are no longer able to decide for themselves alternative concepts, such as advanced care planning, should be considered.