预先指令修订 (2002年与2023年):我们是否更接近统一性?
George R Luck1, Adriana Bautista1,2, Darian Peters1
1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.
The Gerontologist
|August 10, 2024
概括
自2002年以来,预先指示 (ADs) 显示出最小的统一性变化,导致终生护理 (EOL) 混乱. 建议对ADs的统一法案进行修订,以便在各州更好地了解患者的偏好.
科学领域:
- 医疗保健法律 医疗保健法律
- 生物伦理学生物伦理学
- 公共卫生政策 公共卫生政策
背景情况:
- 各州的法律规定了预先指示 (AD),导致结构和术语的变化.
- 这种变化导致不一致的生命终端 (EOL) 护理,患者在不同州之间移动.
- 2002年之前的一项研究发现了ADS的显著差异,促使了这一比较分析.
研究的目的:
- 确定自2002年以来,预先指示 (AD) 是否变得更加统一.
- 评估AD文件类型的变化和解决的关键问题.
- 在EOL护理计划中发现持续存在的不一致性.
主要方法:
- 分析2023年所有50个州和哥伦比亚特区的AD法规.
- 将目前的发现与2002年关于AD统一性的研究数据进行比较.
- 使用非参数方法和t测试对文档类型和关键问题进行统计比较.
主要成果:
- 提供医疗保健代理人权 (HCPOA) 和生活遗嘱 (LW),称为医疗保健预先指示 (ADHC) 的州数量从13个增加到30个.
- 在LW和ADHC文件中,长期护理条款显著增加.
- 在LW文件中,人工养生条款显著增加,但只有10%的州解决了阿尔茨海默氏症.
- 尽管有趋势,但到2023年,只有3个州仅为HCPOA提供法规.
结论:
- 自2002年以来,预先指令 (ADs) 的修订较少,缺乏统一性.
- 这种不一致性可能会导致理解和尊重患者的EOL愿望的混乱.
- 建议对"统一提前指令法"进行修订,以提高统一性,并确保在各州尊重患者的偏好.
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