Abstract
(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = −0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.
Highlights
Technological progress and advances in medical knowledge have made it possible to offer a longer life, not always with the desired quality of life, such as the case of disproportionate use of treatment in terminally ill patients, therapeutic obstinacy, or dysthanasia [1]
Advance Care Directives (ACDs) emerged from the need to reinforce the principle of self-determination in the context of significant medical-scientific developments, mainly to support human life when the patient is not in possession of their mental abilities
Considering the importance of religion in these types of questions, we found a high percentage of Catholics, 82.62% (n = 846)
Summary
Technological progress and advances in medical knowledge have made it possible to offer a longer life, not always with the desired quality of life, such as the case of disproportionate use of treatment in terminally ill patients, therapeutic obstinacy, or dysthanasia [1]. The concept of a patient’s right to self-determination is currently gaining importance and centrality when deciding what to do, while the traditional paternalistic posture of health professionals is hardly acceptable in the current context [1]. Advance Care Directives (ACDs) emerged from the need to reinforce the principle of self-determination in the context of significant medical-scientific developments, mainly to support human life when the patient is not in possession of their mental abilities. The ACD is the first legal tool to formally communicate one’s will regarding health care at the EOL [2]. An ACD indicates, usually as a written statement, a person’s preferences about medical treatments and decisions to be made when they are no longer mentally capable of communicating them, regarding life-sustaining treatments that should be withheld/withdrawn [3]
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