A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work?

Purpose: To explore hospitalized patients' attitudes toward advance directives, their reasons for completing or not completing advance directive forms, and demographic differences between patients who did and did not complete advance directive forms.

Design and Method: The convenience sample comprised 30 hospitalized patients in North Carolina. Participants were interviewed using an adapted advance directive attitude survey (ADAS), and were asked five general questions about advance directives. Validity and reliability were established on the adapted tool.

Findings: The overwhelming majority of participants had received information on advance directives and they were moderately positive about them. The majority who had completed advance directives were Caucasian, female, over age 65, had less than a high school education, and perceived their health as poor. Most believed that an advance directive would ensure they received the treatment they desired at the end of life.

Conclusions: Patients' attitudes alone did not determine who will and will not complete advance directives. Most participants who completed advance directives had specific reasons for doing so. Nurses have responsibility for discussing advance directives with patients, families, and physicians to ensure adequate education about the completion of advance directives.

Patients' attitudes toward advance directives.

http://hub.hku.hk/bitstream/10722/139467/1/Content.pdf

Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong.

BACKGROUND The Patient Self-Determination Act (PSDA) (part of the Omnibus Budget Reconciliation Act of 1990) requires that all healthcare institutions receiving Medicare and Medicaid funds inform patients about their right to participate in healthcare decisions, including their right to have an advance directive. Advance directives (ADs) allow an individual to participate indirectly in future medical care decisions if he or she becomes decisionally incapacitated. Despite passage of this bill and mechanisms within most healthcare institutions to provide this information, the AD completion rate remains low. PURPOSE The purpose of this study was to identify the significant attitudes and factors that influence the completion of ADs among adult hospitalized patients admitted to medical/surgical units. DESIGN Descriptive correlational survey design. METHODS A convenience sample of patients admitted to medical-surgical units during a 2-month period completed face-to-face interviews and completion of the Advance Directive Attitude Survey. FINDINGS Eighty-two percent of the sample identified having received information on ADs, although hospital policy had it distributed to all patients on admission. Eighteen percent of the sample had completed an AD, and an additional 8% completed an AD after the interview and accompanying education during the interview for a 26% completion rate. The mean attitude toward ADs was slightly positive, and there was no difference in attitude score between those with an AD and those without. IMPLICATIONS Low completion rates of ADs among the majority of the population and even lower among ethnically diverse individuals despite favorable attitudes toward ADs suggest that there are factors beyond access to information that may influence the decision not to complete an AD. Results of this study are congruent with other research raising the question of whether ADs as currently designed are appropriate for all groups.

Attitudes toward advance directives and advance directive completion rates.

Nurses are increasingly faced with situations in practice regarding the prolongation of life and withdrawal of treatment. They play a central role in the care of dying people, yet they may find themselves disempowered by medical paternalism or ill-equipped in the decision-making process in end-of-life situations. This article is concerned with the ethical relationships between patient autonomy and medical paternalism in end-of-life care for an advanced cancer patient. The nurse's role as the patient's advocate is explored, as are the differences between nursing and medicine when confronted with the notion of patient autonomy. The impetus for this discussion stems from a clinical encounter described in the following scenario.

Mark Bruder

Papers

Patients' attitudes toward advance directives and end-of-life treatment decisions.