Advance Directives Among Community-Dwelling Stroke Survivors (P6-5.016)

Abstract

<h3>Objective:</h3> To identify determinants of Advance Directives (ADs) among community-dwelling stroke survivors. <h3>Background:</h3> Advance directives (ADs) are integral to health care, allowing patients to specify surrogate decision-makers and treatment preferences in case of loss of capacity. The present study sought to identify determinants of ADs among stroke survivors. <h3>Design/Methods:</h3> In this cross-sectional study (Care Attitudes and Preferences in Stroke Survivors [CAPriSS]), community-dwelling stroke survivors were surveyed on ADs; validated scales were used to query palliative care knowledge and attitudes towards life-sustaining treatments. Logistic regression was used to determine variables associated with ADs. <h3>Results:</h3> The median age among the 421 participants was 69 years (IQR 58–75 years); 53.7% were male; and 15.0% were Black. Two hundred and fifty-one (59.6%) respondents had ADs. Compared to participants without ADs, participants with ADs had higher Palliative Care Knowledge Scale (PaCKS) scores (median 10 [IQR 5–12] vs. 7 [IQR 0–11], p&lt;0.001), and lower scores on the Attitudes Towards Life-Sustaining Treatments Scale (indicating a more negative attitude towards life-sustaining treatments; median 23 [IQR 18–28] vs. 29 [IQR 24–35], p&lt;0.001). Multivariable logistic regression identified age (OR 1.62 per 10 year increase, 95% CI 1.30–2.02; p&lt;0.001), prior advance care planning discussion with a physician (OR 1.73, 95% CI 1.04–2.86; p=0.034), PaCKS score (OR 1.06 per 1 point increase, 95% CI 1.01–1.12; p=0.018), and Attitudes Towards Life-Sustaining Treatments Scale score (OR 0.91 per 1 point increase, 95% CI 0.88–0.95; p&lt;0.001) as variables independently associated with ADs. <h3>Conclusions:</h3> Age, prior advance care planning discussion with a physician, palliative care knowledge, and attitudes towards life-sustaining treatments were independently associated with ADs. <b>Disclosure:</b> Ms. Gupta has nothing to disclose. Miss Chen has nothing to disclose. Miss Suolang has nothing to disclose. Ms. Cooper has nothing to disclose. Dr. Gottesman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. The institution of Dr. Gottesman has received research support from NIH. Dr. Faigle has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for several law firms. The institution of Dr. Faigle has received research support from The Morninstar Foundation.