Cancer Res Treat.  2016 Apr;48(2):753-758. 10.4143/crt.2015.281.

Adopting Advance Directives Reinforces Patient Participation in End-of-Life Care Discussion

• Hong JH
• Kwon JH
• Kim IK
• Ko JH
• Kang YJ
• Kim HK

• KMID: 2454353
• DOI: http://doi.org/10.4143/crt.2015.281

Abstract

PURPOSE
In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives.
MATERIALS AND METHODS
Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated.
RESULTS
Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients' poor condition after late referral was the main barrier to missing EOL discussions; however, family members' concerns about patient's distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively.
CONCLUSION
Our results suggested that the use of advance directive promote patient participation in EOL discussion.

Keyword

Advance directives; Personal autonomy; Decision making

MeSH Terms

Advance Directives*
Cardiopulmonary Resuscitation
Decision Making
Diagnosis
Education
Hospices
Humans
Korea
Medical Records
Multivariate Analysis
Patient Participation*
Personal Autonomy
Referral and Consultation
Renal Dialysis
Retrospective Studies

Figure

• 

  Fig. 1. Study flow. AD, advance directive; DNR, do-not-resuscitate; HC, hospice center; EOL, end-of-life.

Reference

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