Association between advance directives and quality of end-of-life care: a national study.

摘要: OBJECTIVES: To examine the role of advance directives (ADs) 10 years after Patient Self-Determination Act. DESIGN: Mortality follow-back survey. SETTING: People who died in a nursing home, hospital, or at home. PARTICIPANTS: Bereaved family member other knowledgeable informant. MEASUREMENTS: Telephone interviewers that asked about use written ADs, life-sustaining treatment, and quality care by asking whether staff provided desired symptom relief, treated dying with respect, supported shared decision-making, coordinated care, needed information emotional support. RESULTS: Of 1,587 people died, 70.8% had an AD. Persons home hospice were more likely to have In addition, those AD less feeding tube (17% vs 27%) respirator last month life (11.8% 22.0%). members reported decedent did not report concerns physician communication (adjusted odds ratio (AOR)=1.4, 95% confidence interval (CI)=1.1–1.6) being informed what expect (AOR=1.2, CI=1.0–1.3). No statistically significant differences observed outcomes. Even AD, important remained; one four unmet need pain, two inadequate support for patient, three stated support. CONCLUSION: completion was associated greater fewer communication, yet opportunities remain improve end-of-life care.