Abstract：
OBJECTIVE: Advance directives (AD) are based on state-specific statutes that vary in structure, terminology, and options. This variability leads to inconsistent end-of-life (EOL) care for patients who have executed an AD in one state but fall ill in another state. This study revisits a 2002 article that identified considerable differences in ADs to determine whether ADs have become more uniform.
METHODS: ADs from all 50 states and the District of Columbia were examined to determine the frequency of document types and seven key issues. The results were = compared to the 2002 study using non-parametric approaches. Mean numbers of key issues were compared using t-tests and one-way ANOVA.
RESULTS: Consistent with 2002, three states in 2023 provide statutes for Health Care Power of Attorney (HCPOA). However, states offering a combined HCPOA, and living will (LW), deemed an advance directive for health care (ADHC), increased from 13 to 30. Between both studies, Long Term Care increased significantly in LW and ADHC, while Artificial Sustenance significantly increased in LW. Despite the rising prevalence of Alzheimer\'s in the United States, only 10% of states included this issue in 2023.
CONCLUSIONS: Despite evolving healthcare trends, minimal revisions have been made to ADs since 2002. This lack of uniformity can cause confusion regarding proper understanding of EOL wishes. The authors recommend that the Uniform Act for Advance Directives be revisited to promote greater uniformity in ADs and ensure that individuals\' preferences are understood and respected across different states.
METHODS: ADs from all 50 states and the District of Columbia were examined to determine the frequency of document types and seven key issues. The results were = compared to the 2002 study using non-parametric approaches. Mean numbers of key issues were compared using t-tests and one-way ANOVA.
RESULTS: Consistent with 2002, three states in 2023 provide statutes for Health Care Power of Attorney (HCPOA). However, states offering a combined HCPOA, and living will (LW), deemed an advance directive for health care (ADHC), increased from 13 to 30. Between both studies, Long Term Care increased significantly in LW and ADHC, while Artificial Sustenance significantly increased in LW. Despite the rising prevalence of Alzheimer\'s in the United States, only 10% of states included this issue in 2023.
CONCLUSIONS: Despite evolving healthcare trends, minimal revisions have been made to ADs since 2002. This lack of uniformity can cause confusion regarding proper understanding of EOL wishes. The authors recommend that the Uniform Act for Advance Directives be revisited to promote greater uniformity in ADs and ensure that individuals\' preferences are understood and respected across different states.
摘要：
目标：预先指令（AD）基于结构不同的州特定法规，术语,和选项。这种可变性导致在一种状态下执行AD但在另一种状态下生病的患者的不一致的生命终止(EOL)护理。这项研究回顾了2002年的一篇文章，该文章确定了广告中的相当大的差异，以确定广告是否变得更加统一。
方法：对来自所有50个州和哥伦比亚特区的AD进行了检查，以确定文件类型的频率和七个关键问题。结果与2002年使用非参数方法的研究进行了比较。使用t检验和单因素方差分析比较关键问题的平均数。
结果：与2002年一致，2023年的三个州提供了医疗保健授权书（HCPOA）的法规。然而,各州提供联合的HCPOA，和生活意志（LW），被视为医疗保健预先指令(ADHC)，从13增加到30。在这两项研究之间，LW和ADHC的长期护理显着增加，而LW的人工支持显着增加。尽管阿尔茨海默氏症在美国的患病率上升，2023年，只有10%的州纳入了这一问题。
结论：尽管医疗保健趋势不断发展，自2002年以来，对广告的修订最少。这种缺乏统一性会导致对EOL愿望的正确理解的混乱。作者建议重新审视《统一预先指令法》，以促进广告的更大一致性，并确保不同州的个人偏好得到理解和尊重。
方法：对来自所有50个州和哥伦比亚特区的AD进行了检查，以确定文件类型的频率和七个关键问题。结果与2002年使用非参数方法的研究进行了比较。使用t检验和单因素方差分析比较关键问题的平均数。
结果：与2002年一致，2023年的三个州提供了医疗保健授权书（HCPOA）的法规。然而,各州提供联合的HCPOA，和生活意志（LW），被视为医疗保健预先指令(ADHC)，从13增加到30。在这两项研究之间，LW和ADHC的长期护理显着增加，而LW的人工支持显着增加。尽管阿尔茨海默氏症在美国的患病率上升，2023年，只有10%的州纳入了这一问题。
结论：尽管医疗保健趋势不断发展，自2002年以来，对广告的修订最少。这种缺乏统一性会导致对EOL愿望的正确理解的混乱。作者建议重新审视《统一预先指令法》，以促进广告的更大一致性，并确保不同州的个人偏好得到理解和尊重。
