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LIVING WILLS: FOR PRIMARY CARE, AIDS AND CANCER PATIENTS

生前遗嘱：针对初级保健、艾滋病和癌症患者

基本信息

批准号：
3371719
负责人：
JOHN STOECKLE
金额：
$ 4.95万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
1989
资助国家：
美国
起止时间：
1989-03-01 至 1991-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/3371719
关键词：
AIDS cancer rehabilitation /care decision making ethics health related legal human rights patient /disease registry preference primary care physician resuscitation terminal patient care

项目摘要

It has been postulated that ethical decision making regarding medical interventions for the terminally ill would be improved by widespread use of comprehensive living wills. Use of the Do Not Resuscitate order, although helpful, has been shown to be inadequately used, and is only one of a large spectrum of decisions that need to be made. It has therefore been suggested that the best available protection of patients' rights to choose limited or extensive medical intervention would be provision for making a comprehensive living will for all patients, analogous to the routine preparation of regular wills. We will study features of this suggestion, including the practicability of physicians opening the discussion in primary care and specialty care practices for ambulatory patients. The study will make use of a specifically designed living will format with options for a variety of medical interventions in case of several types of impairment. This living will is included as part of a survey designed to assess inclination to discuss terminal care and to give preferences for treatment in specific circumstances, and preferences for who should make which decisions. The durability of patients positions will be assessed by re-administering the survey 6 to 12 months after the initial survey and at the time of any interium hospitalization. Cohorts include the following: a) 388 patients seen in primary care physicians practices. b) 291 patients with acquired immunodeficiency syndrome. These patients in these two cohorts will be surveyed either by the physician or a research assistant. c) 410 patients from a telephone registry. These individuals will be surveyed by telephone. The study is expected to assess whether comprehensive living wills are practical for physicians and patients, and whether they are desired by patients. The study is expected to provide some models for how physicians and patients can handle the process of indicating preferences for care in case of catastrophic illness, and a model living will format.

有人认为，道德决策，对绝症患者的医疗干预将得到改善，广泛使用全面的生前遗嘱。使用Do Not 复苏顺序，虽然有帮助，已被证明是使用不当，只是众多决策之一，需要做的事因此，有人建议，最好地保护病人选择有限或广泛的医疗干预将提供，所有患者的全面生活意愿，类似于常规遗嘱的常规准备。我们会研究这项建议的特色，包括医生在初级保健中开展讨论的可行性和门诊病人的专科护理实践。研究将使用专门设计的生前遗嘱格式，在几种情况下，损伤的类型。这份生前遗嘱是旨在评估讨论临终关怀倾向的调查，在特定情况下给予优惠待遇，以及谁应该做出哪些决定的偏好。耐久性患者的位置将通过重新给予在初次调查后6至12个月，任何临时住院队列包括以下：a）388例原发性肝癌患者，护理医生的做法。 B）291例获得性免疫缺陷综合症。这两个队列中的患者将由医生或研究助理进行调查。（c）电话登记的410名患者。这些人将通过电话进行调查。这项研究预计将评估全面的生前遗嘱是否对医生和病人都是实用的，患者所期望的。该研究有望提供一些模型医生和病人如何处理表明在灾难性疾病的情况下对护理的偏好，和一个模范生活会的形式。