Patient Perspectives on the Authority of Advance Directives in Times of Conflict: A Mixed Methods Study.

Q3 Medicine
Jordan Potter, David S Reis, Jason Lesandrini, Eric Nelson
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引用次数: 0

Abstract

AbstractContext: As advance directives (ADs) become more frequently utilized, opportunities increase for conflict between a patient's designated healthcare power of attorney (POA) and the treatment preferences outlined in their living will (LW). Little is known about patient preferences regarding how to resolve these conflicts.

Objectives: To assess patient preferences regarding whether their POA or LW should have authority in times of conflict.

Methods: In this mixed methods study, we completed a retrospective chart review to analyze patient selections in their AD, including selections in a novel section of the AD called the "Binding Guidance" section that gives patients the ability to designate whether their POA or LW should have authority when there is conflict between the two. Additionally, willing patient participants were asked two interview questions about their selections to further elucidate their perspectives.

Results: Out of 143 patients, 48.3 percent (n = 69) chose to have their LW followed over their POA and 51.7 percent (n = 74) chose to have their POA followed over their LW. Several statistically significant associations were identified regarding binding guidance selections. Seventy-four (51.75%) of these patients also answered the additional interview questions, with the participants evenly distributed (n = 37 each) in their binding guidance selections.

Conclusion: Patients have varying preferences regarding whether their POA or LW should have authority in times of conflict. ADs should reflect this variation in preferences and allow patients the ability to designate whether they prefer their POA or LW to have ultimate authority when in conflict.

患者对冲突时期预先指示权威的看法:一项混合方法研究。
摘要:随着预先指示(ad)的使用越来越频繁,患者指定的医疗授权书(POA)与其生前遗嘱(LW)中概述的治疗偏好之间冲突的机会增加。关于如何解决这些冲突,我们对患者的偏好知之甚少。目的:评估患者对冲突时POA或LW是否应具有权威的偏好。方法:在这项混合方法的研究中,我们完成了一项回顾性的图表回顾,分析了患者在AD中的选择,包括AD中一个名为“绑定指南”的新部分的选择,该部分使患者能够指定他们的POA或LW在两者之间存在冲突时应该具有权威。此外,自愿的患者参与者被问及两个关于他们选择的访谈问题,以进一步阐明他们的观点。结果:143例患者中,48.3% (n = 69)选择LW随访而不是POA, 51.7% (n = 74)选择POA随访而不是LW。在结合指南的选择上发现了几个统计上显著的关联。74名(51.75%)患者还回答了额外的访谈问题,参与者在其绑定指导选择中分布均匀(n = 37)。结论:患者对冲突时POA或LW是否应该有权威的偏好不同。ad应反映这种偏好的变化,并允许患者有能力指定在冲突时他们是否希望他们的POA或LW拥有最终权威。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Ethics
Journal of Clinical Ethics Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
31
期刊介绍: The Journal of Clinical Ethics is written for and by physicians, nurses, attorneys, clergy, ethicists, and others whose decisions directly affect patients. More than 70 percent of the articles are authored or co-authored by physicians. JCE is a double-blinded, peer-reviewed journal indexed in PubMed, Current Contents/Social & Behavioral Sciences, the Cumulative Index to Nursing & Allied Health Literature, and other indexes.
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