ADVANCE DIRECTIVES--EFFECTIVENESS OF MANDATORY NOTICE

正式的预先指示（生前遗嘱和持久授权书）是 作为最佳医疗决策的一部分而受到广泛鼓励。 到了十二月 1991年，医院参与医疗保险和医疗补助将携带 有义务告知所有成年患者， 这些法律的文件。 这项拟议的研究将建立在一个正在进行的 描述和干预研究（SUPPORT），正在收集 预先指示的频率（以及一系列其他数据）， 在美国五个州，有一万名住院的成年人面临死亡的高风险。 医院的 拟议的研究将提供更详细的信息， 在强制通知生效后收集。 具体目标 包括：1）了解联邦授权要求的影响 提供关于正式预先指示的信息，2）检查 预先指示对医疗决策和结果的影响，3） 识别阻碍或阻碍执行的影响因素 一个预先指示，和4）调查的比率和有效性， 关于预先指示的各种咨询来源。 对于四个以上的 在SUPPORT第二阶段入组的1000名患者中，本研究将 记录的意识，存在，讨论，内容和影响力 正式的预先指示，从进入研究到后续的 六个月 护理和结果的偏好收集在支持和 将检查与正式文件中所述偏好的一致性， 证件 这种设计允许异常全面和有效的研究 一个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.