Patients' understanding and use of advance directives (original) (raw)
Related papers
Perceptions, Attitudes, and Knowledge toward Advance Directives: A Scoping Review
Healthcare, 2013
Abstract: (1) Background: Advance directives are an expression of a person’s autonomy regarding end-of-life care. Several studies have shown that the level of completion in countries where advance directives are legalized is low. To better understand this phenomenon, it is important to know the perceptions, attitudes, and knowledge that the population has about this instrument. The aim of this article was to explore a population’s perceptions and/or attitudes and/or knowledge toward advance directives. (2) Methods: A search was conducted in March 2023 in the ISI Web of Knowledge, Scopus, and PubMed databases using the following keywords: “advance care directives”, “advance care planning”, “perceptions”, “attitudes”, and “knowledge”. Two hundred and twentyfour (224) articles were identified, and thirteen (13) were included for analysis. (3) Results: The selected articles point to a low level of knowledge toward advance directives: they recognise a strong positive attitude of the population toward the implementation of advance directives but a low level of achievement. (4) Conclusions: Studies on perceptions/attitudes/knowledge toward advance directives are important to understand the real needs of the population regarding this issue and to implement more adequate and effective promotion and dissemination measures.
Journal of Medical Ethics, 1999
Objectives-The subject ofpatient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors'decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. Subjects and main outcome measures-A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire with a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. Results-Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. Conclusions-The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues.
Motivations, aims and communication around advance directives
Patient Education and Counseling, 2014
What are motivations of owners of an advance directive (AD) to draft an AD, what do they aim for with their AD and do they communicate about their AD? Methods: Written questionnaires were sent to a cohort of people owning different types of ADs (n = 5768). A purposive sample of people suffering from an illness was selected from the cohort for an indepth interview (n = 29). Results: About half of our population had no direct motivation to draft their AD. Most mentioned motivation for the other half was an illness of a family member or friend. Many different and specific aims for drafting an AD were mentioned. An often mentioned more general aim in people with different ADs was to prevent unnecessary lengthening of life or treatment (14-16%). Most respondents communicated about having an AD with close-ones (63-88%) and with their GP (65-79%). In the interviews people gave vivid examples of experiences of what they hoped to prevent at the end of life. Some mentioned difficulties foreseeing the future and gave examples of response shift. Conclusion: ADs can give directions to caregivers about what people want at the end of life.
Advance directives: the views of health care professionals
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1993
This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques. Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and healt...
Health professionals' views on advance directives: a qualitative interdisciplinary study
Palliative Medicine, 2003
The aim of this study was to discover the views of health professionals in the Greater Glasgow area on advance directives, using semi-structured interviews and focus groups. The twelve participants interviewed included four hospital doctors, four general practitioners (GPs) and four nurses. The six focus groups comprised hospice nurses, GPs, consultant geriatricians, geriatricians in training grades and an interdisciplinary group. Participants were purposively selected to reflect a range of personal experiences with, and attitudes toward, the advance directive using key informants and a short questionnaire. Participants were asked to comment on a specially constructed sample advance directive. All research encounters were recorded, transcribed and analysed using accepted methods in qualitative research. The advance directive was seen as a means of promoting peace of mind in will makers, of allowing carers to honour the patients' wishes and of stimulating communication between al...
Gerontology and Geriatric Medicine
Aim: The aim of this study is to draw attention to the subject of “advanced directives,” to create awareness, whether or not they want to investigate to determine the preferences for medical care and applications in the period of end-of-life while individuals can specify their preferences and wishes for medical decisions and take steps for it. Materials and Methods: The study was carried out on individuals aged 20 years and older in family medicine outpatient clinics. A questionnaire consisting of 30 questions was applied to 300 people who volunteered to participate in the study by a face-to-face interview. Results: Of all participants, 70% had not heard of advance directives (ADs) before this survey. Three quarters of participants thought that advanced directives were necessary. The rate of requesting cardiopulmonary resuscitation (CPR) to prolong survival in the case of end-of-life care was 55%; the rate of requesting the continuation of life-sustaining treatment was 24%. Conclusi...
Defining Features of Advance Directives in Law and Clinical Practice
Chest, 2012
A ll 50 states and the District of Columbia recognize the legal right of competent adults to write advance directives to provide direction for healthcare decisions near the end of life, when the ravages of illness, disease, or injury have taken the ability to decide for one's self. Advance directives may designate someone to make health-care decisions on the Editor's note: This essay is the fourth article in the Law and Medicine curriculum of the ongoing "Medical Ethics" series. To view all articles from the core curriculum, visit http://chestjournal.chestpubs. org/cgi/collection/medethics.-Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics patient's behalf (a "proxy directive" or "durable power of attorney for health care"), state with some specifi city the person's wishes and instructions for care (a "living will" or "instruction directive"), or both (a "combined directive"). Most state statutes recognize both proxies and living wills and allow for combined directives; New York, Massachusetts, and Michigan recognize by statute only the health-care proxy. 1 This article reviews the defi ning features of advance directives and the governing law. I discuss some common In the. 30 years since the New Jersey Supreme Court's seminal opinion in the case of Karen Ann Quinlan, all 50 states and the District of Columbia have enacted legislation to recognize the legal right of competent adults to write advance directives. The purpose of advance directives is to provide direction for health-care decisions near the end of life, when the ravages of illness, disease, or injury have taken the ability to decide for one's self. This article reviews the defi ning features of advance directives and the governing law, discusses some common practical concerns regarding the use and effectiveness of advance directives, and identifi es several signifi cant ethical-legal challenges for honoring advance directives at the bedside. With a primary focus on the health-care proxy, the anatomy of advance directives is analyzed under four general rubrics: formal requirements, decisional capacity and when the directive takes effect, rights and responsibilities of proxies and health-care providers, and the scope and limitations of decisions to forego life-sustaining treatment. There is much common ground among state laws, but particular legal provisions may vary from state to state. Physicians, nurses, social workers, and other health-care professionals should be familiar with the law of their home state.
Advance directives and living wills
PubMed, 1993
Advance directives are documents which enable people to decide what will happen to them, or who will make decisions on their behalf, if a time comes when they are no longer able to participate in discussions or decisions about their own health care. This paper briefly examines the underlying philosophy of advance directives, and the manner in which they have evolved in the United States. It concludes by considering their legal status in the United Kingdom which, until recently, was not entirely clear.