ADVANCE DIRECTIVES--EFFECTIVENESS OF MANDATORY NOTICE

正式的预先指示(生前遗嘱和持久授权书)是 广泛鼓励将其作为最佳医疗决策的一部分。到12月 1991年，医院参与医疗保险和医疗补助将带来 有义务告知所有成年患者可用和有用的药物 这些法律文件。这项拟议的研究将建立在正在进行的 描述和干预研究(支持)正在收集 高级指令(以及其他数据数组)的频率 在美国的五个国家中，有1万名住院的成年人有很高的死亡风险。 医院。拟议的研究将允许提供更详细的信息 在强制通知生效后收取。具体目标 包括：1)了解联邦授权要求的影响 提供有关正式预先指令的信息，2)检查 预先指示对医疗决策和结果的影响，3)到 确定作为执行的障碍或鼓励的影响 一项先行指令，以及4)调查 关于预先指令的各种咨询来源。四张以上的票 千名患者参加第二阶段的支持，这项研究将 记录对…的认识、存在、讨论、内容和影响 正式的预先指示，从进入研究到后续的 六个月。对护理和结果的偏好收集在支持和 将检查是否与正式表格中陈述的偏好一致 文件。这种设计使研究变得异常全面和高效 一项非常重要的公共政策干预。

Formal advance directives (living wills and durable powers of attorney) are widely encouraged as part of optimal medical decision-making. By December 1991, hospital participation in Medicare and Medicaid will carry the obligation to inform all adult patients of the availability and utility of these legal documents. This proposed study will build upon an ongoing description and intervention study (SUPPORT) that is collecting the frequency of advance directives (as well as an array of other data) among ten thousand hospitalized adults who are at high risk of dying in five U.S. hospitals. The proposed study will allow much more detailed information to be collected after the mandated notice is effectuated. Specific aims include: 1) to understand the impact of the federally mandated requirement to provide information about formal advance directives, 2) to examine the impact of advance directives on medical decisions and outcomes, 3) to identify influences that serve as barriers or encouragements to executing an advance directive, and 4) to investigate the rates and effectiveness of various sources of counselling about advance directives. For the over four thousand patients enrolled in the second phase of SUPPORT, this study will document the awareness, existence, discussion, content, and influence of formal advance directives, from entry into the study through a follow-up of six months. Preferences for care and outcomes are collected in SUPPORT and will be examined for concordance with the preferences stated in the formal documents. This design allows unusually comprehensive and efficient study of a very important public policy intervention.