背景:签署预先指示(AD)可确保绝症患者获得临终护理,根据他们的意愿,从而促进人的尊严,使他们免于不必要的痛苦。尽管2000年台湾颁布了《临终关怀姑息治疗法》,但发现慢性病患者的AD完成率很低。迄今为止,关于台湾绝症患者AD完成相关因素的现有研究有限.为了探索签名AD的特征,比较有和没有癌症的患者在签署AD上的差异,并检查与绝症患者签署AD相关的因素。
方法:一项全国性的研究是通过回顾性研究从北方18家随机选择的医院收集的医疗死亡记录进行的。中央,和台湾南部。我们收集了200条记录,包括癌症和非癌症相关的死亡,每个医院进行了单变量和多变量后勤回归,以检查与所有患有和不患有癌症的患者中签署预先指示相关的因素。
结果:在3004份审查的医疗记录中,79%的人签署了广告,大多数(95%)是由病人的照顾者签名的。较高的教育水平(OR=1.52,95%CI=1.10,2.08,p=0.010);癌症诊断(OR=2.37,95%CI=1.79,3.16,p<0.001);有家庭成员(OR=5.62,95%CI=2.95,10.69,p<0.001),疗养院(OR=4.52,95%CI=1.97,10.38,p<0.001),朋友,或作为主要照顾者的女佣(OR=3.82,95%CI=1.76,8.29,p=0.001);知道自己预后不良的患者(OR=15.39,95%CI=5.66,41.83,p<0.001)与更高的签署AD的可能性相关。
结论:非恶性慢性疾病患者比癌症患者更不可能有患者或家庭照顾者签署的广告,在心血管疾病患者中观察到的可能性最低。只要有可能,主要护理人员应该参与与患者讨论AD,应该加强讲真话的重要性。遵循这些原则,每个患者的临终护理偏好都可以得到尊重,从而提高患者死亡前的护理质量。
BACKGROUND: Signing advance directives (ADs) ensures that terminally ill patients receive end-of-life care, according to their wishes, thereby promoting human dignity and sparing them from unnecessary suffering. Despite the enactment of the Hospice Palliative Care Act in Taiwan in 2000, the completion rates of ADs have been found to be low among patients with chronic illness conditions. To date, limited existing research is available regarding the factors associated with AD completion in terminally ill patients in Taiwan. To explore signed AD characteristics, compare differences in signing ADs between patients with and without cancer, and examine the factors associated with signing ADs in terminally ill patients.
METHODS: A nationwide study was conducted using data collected via a retrospective review of medical death records from 18 randomly selected hospitals in the northern, central, and southern parts of Taiwan. We collected 200 records, including both cancer and non-cancer-related deaths, from each hospital. Univariate and multivariate logistics regressions were conducted to examine factors associated with signing advance directives among all patients- with and without cancer.
RESULTS: Among the 3004 reviewed medical records, 79% had signed ADs, with most (95%) being signed by patients\' caregivers. A higher education level (OR = 1.52, 95% CI = 1.10, 2.08, p = 0.010); cancer diagnosis (OR = 2.37, 95% CI = 1.79, 3.16, p < 0.001); having family members (OR = 5.62, 95% CI = 2.95, 10.69, p < 0.001), care homes (OR = 4.52, 95% CI = 1.97, 10.38, p < 0.001), friends, or maids (OR = 3.82, 95% CI = 1.76, 8.29, p = 0.001) as primary caregivers; and patients knowing about their poor prognosis (OR = 15.39, 95% CI = 5.66, 41.83, p < 0.001) were associated with a higher likelihood of signing ADs.
CONCLUSIONS: Patients with non-malignant chronic illnesses were less likely to have ADs signed by either patients or family caregivers than those with cancer, with the lowest likelihood observed in patients with cardiovascular diseases. Whenever possible, primary caregivers should be involved in discussing ADs with patients, and the importance of truth telling should be reinforced. Following these principles, each patient\'s end-of-life care preferences can be respected, thereby promoting quality of care before the patient\'s death.