Advance Directives Attitudes Research Articles

A CROSS-CULTURAL ANALYSIS OF PREFERENCES AND ATTITUDES TOWARD ADVANCED DIRECTIVES IN TAIWAN AND THAILAND

Abstract Introduction Advance directives (ADs) are pivotal in healthcare planning, indicating preferences for medical treatment in critical conditions. This study examines ADs attitudes and experiences between Taiwan and Thailand, highlighting cultural influences on end-of-life care. Method Employing pairing matching, the study selected 259 matched pairs from an initial Taiwanese pool of 1488 and a Thai sample of 268 based on gender, age, education, and medical work background. Demographics included 72.2% females, with an average age of 32.91 (range 18-72), 92.3% holding a bachelor’s degree or higher, and 95% working in health-related fields. Results The comparison revealed no significant differences in the perceived necessity of ADs at the current life stage or in the preference for familial decision-making during hospitalization. However, significant disparities emerged in several areas, including comfort in discussing death (Taiwan 95.8%, Thailand 84.6%) and willingness to discuss end-of-life care (Taiwan 96.1%, Thailand 91.5%). A substantial gap was found in the belief regarding peers’ consideration of ADs, with 84.6% of Taiwanese versus 49% of Thais believing their age group would consider such directives. Furthermore, all eight aspects related to the desired qualities of healthcare agents showed significant differences, with Taiwanese respondents valuing trust, communication, understanding, and support more highly than their Thai counterparts. Conclusions The study underscores cultural differences in attitudes towards advance directives between Taiwan and Thailand, particularly in discussions about end-of-life care and qualities desired in healthcare proxies. These findings highlight the need for culturally tailored approaches to enhance awareness and acceptance of advance directives in both regions.

Advance Directives in Portugal: A Qualitative Survey.

(1) Background: Advance directives (ADs) in Portugal have been legalized since 2012. What has been observed over time, from the few studies carried out, is that despite the positive attitudes in the population, there is a low level of adherence to ADs. To try to understand the reasons for these data, the current study aimed to explore and describe the experiences of the Portuguese population regarding AD. (2) Methods: For this exploratory and descriptive qualitative study, the researchers conducted open (unstructured) interviews with a convenience sample aged over 18 years until data saturation was achieved. (3) Results: A total of fifteen interviews were conducted-eight with women and seven with men. The following four categories emerged from the content analysis of the interviews: (1) AD literacy, (2) AD relevance, (3) AD attitudes, and (4) conditionalities for compiling the ADs. (4) Conclusions: The study pointed out the good receptivity of the participants to the ADs; however, literacy on this subject was low, and identifying the conditionalities in the development of ADs could contribute to improvements in implementation in the population. The data from this study suggest the need to implement measures to increase the literacy of the Portuguese population on ADs and review the legal framework for improving the accessibility of the citizen population. There is also a need to continue researching and obtain more evidence about the ways in which the Portuguese population perceives ADs; thus, in this way, a society can better respond to its citizens' right to freely exercise their prospective autonomy at the end of their lives.

Validity and Reliability of the Korean Version of Advance Directives Attitude Scale for Nurses

Purpose : This study aimed to verify the validity and reliability of the Korean version of the nurses’ attitude scale toward advance directives of patients.Methods : We translated and back-translated the original tool consisting of 20 questions and tested and verified its content validity. Questions for which its content validity has been verified, a preliminary investigation was conducted among 20 nurses working in ICU, followed by the actual investigation. Data were analyzed using SPSS version 24.0 for Windows and Mac and AMOS version 24.0. To verify the validity, an item analysis was conducted for all 398 samples, and then an exploratory factor analysis for 200 samples that were randomly selected, followed by a confirmatory factor analysis for the remaining 198 samples.Results : Korean version of advance directives attitude scale (K-ADAS) consisting of 14 questions – 7 questions on ‘patient rights,’ 4 questions on ‘role of a nurse,’ and 3 questions on ‘ethical judgment’ – was verified its validity and reliability.Conclusion : In this study, the validity and reliability of the K-ADAS have been verified. We expect the verified tool to be useful in various fields that measuring the nurses’ attitude toward advance directives of patients.

The Impact of Advance Directive Perspectives on the Completion of Life-Sustaining Treatment Decisions in Patients with Heart Failure: A Prospective Study.

Evidence for non-modifiable and modifiable factors associated with the utilization of advance directives (ADs) in heart failure (HF) is lacking. The purpose of this study was to examine baseline-to-3-month changes in knowledge, attitudes, and benefits/barriers regarding ADs and their impact on the completion of life-sustaining treatment (LST) decisions at 3-month follow-up among patients with HF. Prospective, descriptive data on AD knowledge, attitudes, and benefits/barriers and LSTs were obtained at baseline and 3-month follow-up after outpatient visits. Of 64 patients (age, 68.6 years; male, 60.9%; New York Heart Association (NYHA) classes I/II, 70.3%), 53.1% at baseline and 43.8% at 3-month follow-up completed LST decisions. Advanced age (odds ratio (OR) = 0.91, p = 0.012) was associated with less likelihood of the completion of LST decisions at 3-month follow-up, while higher education (OR = 1.19, p = 0.025) and NYHA class III/IV (OR = 4.81, p = 0.049) were associated with more likelihood. In conclusion, advanced age predicted less likelihood of LST decisions at 3 months, while higher education and more functional impairment predicted more likelihood. These results imply that early AD discussion seems feasible in mild symptomatic HF patients with poor knowledge about ADs, considering the non-modifiable and modifiable factors.

Differential Acceptance of Advance Directives Between Millennials and Baby Boomer Generations: A Cross-Sectional Survey Study Among College Students and Their Relatives.

Objectives: This study aims to explore the differentials of knowledge and attitude of advance directives (ADs) between millennials and baby boomer generations, and the effects of the intention to sign the advance directives. Methods: This is a cross-sectional study using a self-administered questionnaire to collect data from 325 students in a health-related college of a University of Science and Technology in Taiwan, and their parents, as total of 226, who are baby boomers. The statistical methods include descriptive statistics and inferential statistics. Results: Only 10 people from the 2 generations signed an AD. The multivariate logistic regression showed that baby boomer generation, AD knowledge, and AD attitude were significant positive associate of willingness to sign AD in the future. Conclusions: The government may enhance promotion of ADs among millennials and improve the connection between millennials' knowledge of and attitude toward ADs, and their AD signing behavior.

Advance Care Planning Among Chinese Americans Through a Web-Based Culturally Tailored Education Program.

At any time, a medical crisis could result in an individual too sick to make one's own health care decisions. Advance care planning (ACP) is an important step to ensure that each person receives the medical care desired. Despite its significant importance and proven benefits, the completion rate for advance directive is approximately one-third among the general population in the United States and lower among Chinese Americans. This study explored Chinese Americans' knowledge and attitudes about ACP following completion of a web-based culturally tailored health education program. Ninety-six individuals completed the study between October 1 and December 31, 2020. Prestudy-poststudy outcomes measured included the Advance Directive Knowledge Survey and Advance Directive Attitude Scale administered before and after completion of the education program. Each measure has 9 questions and 16 questions, respectively. Participants' Advance Directive Knowledge Survey scores (pre: mean, 6.04 [SD, 2.28]; post: mean, 8.75 [SD, 0.53]; P < .01) and Advance Directive Attitude Scale scores (pre: mean, 47.31 [SD, 5.69]; post: mean, 53.59 [SD, 4.37]; P < .01) increased significantly following program completion. Findings indicated feasibility for integration of web-based technology and culturally tailored approaches to promote ACP knowledge and attitudes among Chinese Americans.

Abstract 14098: Comparisons of Advance Directive Attitudes, Perceived Susceptibility, and End-of-life Life-sustaining Treatment Preferences Between Patients With Heart Failure and Cancer Survivors and the Relationships

Introduction: The needs for advanced care planning, including preferences to life-sustaining treatments (LSTs), in patients with heart failure (HF) are comparable to or higher than those in cancer survivors, but they had less access to such care than cancer survivors. Diagnostic context and patients’ attitudes and perceived susceptibility can impact preferences to LSTs, but there is limited evidence on these relationships. Purpose: To compare LST preferences, attitudes, and perceived susceptibility between patients with HF and cancer survivors, and to examine the associations of these variables with their preference for each LST (cardiopulmonary resuscitation [CPR], ventilation support, hemodialysis, and hospice care). Methods: Secondary data on LST preferences (the Korean-Advance Directive), attitudes toward advance directive (Advance Directive Attitude Survey), perceived susceptibility (Perceived Susceptibility subscale of the Advance Care Planning survey), and demographic characteristics were obtained from 36 outpatients with HF (mean age, 65.44 years; male, 69.4%) and 107 cancer survivors (mean age, 67.39 years; male, 32.7%). To compare LST preferences, attitudes, and perceived susceptibility between the wo diagnostic groups, chi-square test, t -test, and Wilcoxon rank sum test were used. To examine the relationships of diagnostic context, attitudes, and perceived susceptibility to preferences for each LST, controlling for sex, marital status, and educational level, multivariable logistic regression analyses were used. Results: More patients with HF preferred CPR than cancer survivors (41.7% and 15.9%, χ 2 = 8.88, P = 0.003). Attitudes and perceived susceptibility were similar between the two diagnostic cohorts ( P = .508 and P = .062, respectively). Patients with HF had greater odds of preferring CPR (odds ratio [OR] = 3.02, confidence interval [CI] = 1.19, 7.70) than cancer survivors. Patients with more positive attitudes had greater odds of preferring hospice care (OR = 1.14, CI = 1.06, 1.23). Conclusions: Diagnostic context and patients’ attitudes were associated with preferences for LSTs. Therefore, diagnostic context and improvement in attitudes need to be considered to facilitate informed decision-making for LSTs.

Improving Patient Preparedness and Confidence in Discussing Advance Directives for End-of-Life Care with Health Care Providers in the United States and Japan.

The low completion rate of advance directives (ADs) has received attention in Japan and the United States, as policy makers and health care professionals face aging populations with multiple comorbidities. Among the barriers to AD planning, cultural values and attitudes appear to be particularly influential. A comparison of culturally distinct societies provides a deeper understanding of these barriers. Through such an approach, this study identifies strategies for increasing AD planning among late-middle-age Japanese and US individuals. After giving informed consent for the Institutional Review Board-approved study, Japanese and US respondents (45-65 y; 50% female) without ADs completed a language-appropriate online survey. Participants were asked to review a decision aid as part of a scenario-based physician consultation regarding artificial nutrition and hydration (ANH). Hypotheses were analyzed using multigroup structural equation modeling. Important similarities were identified across the 2 groups. After reviewing the decision aid, both samples strongly preferred "no ANH." Respondents who strongly valued either self-reliance or interpersonal relationships experienced greater preparedness for AD planning. In both countries, greater decision preparedness and positive death attitude predicted greater confidence to discuss care options with a provider. Finally, cultural values predicted preference for family participation: respondents with a strong interdependent self-concept desired more family involvement, whereas high independents preferred less. Findings indicate the importance of documenting care preferences and accounting for individual differences. To increase AD adoption, providers should identify patient segments likely to benefit most from the interventions. Targeting individuals in both countries who value self-reliance and interpersonal relationships appears to be a good place to begin. Such individuals can be identified clinically through administration of validated measures used in this study.

The impact of an advance care planning intervention for patients hospitalized with acute decompensated heart failure

BackgroundMany patients with heart failure (HF) have not addressed end-of-life planning. ObjectiveEvaluate the impact of an advance care planning (ACP) intervention on patients hospitalized with acute decompensated HF. MethodsA convenience sample of patients hospitalized with HF completed the Advance Directive Attitude Survey (ADAS) before The Conversation Project intervention. Post-intervention scores were collected after 30 days. ResultsAll participants (n = 30) had positive pre-intervention ADAS scores. Post-intervention scores revealed no significant change (p = 0.53). Twenty eight percent completed an advance directive (AD), 64% discussed the AD with a significant other, 40% established a surrogate decision maker, and 12% discussed the AD with a provider. ConclusionsAdvance directive completion rates were low despite participants having positive attitudes regarding their value. Discussion of goals between the patient and significant other is an important factor in end-of-life planning. Further studies are needed on strategies to improve provider discussions and AD completion.

Application of social ecological model to Taiwanese end-of-life communication and healthcare planning

<h2>ABSTRACT</h2><h3>Background</h3> Cultural and social backgrounds shape how people regard health, illness and death, and also play a significant role in end-of-life (EOL) decision-making in the face of uncertainty and distress. EOL communication and planning can be complex in a society where families play an important role in decision-making for EOL care in Taiwan. <h3>Aim</h3> This study aimed to identify the significance of cultural, community, interpersonal and individual determinants of EOL communication and healthcare planning. <h3>Methods</h3> A social ecological model was applied to underpin the study. A random sample of 2000 adults aged 20 years or above was selected from the electoral roll in a metropolitan area in southern Taiwan. Adults were told that if they did not wish to participate in the study, they could either return a non-participation form or not complete the questionnaires. Hierarchical multiple regression analyses were used to determine the significance of different societal levels of factors on EOL communication and healthcare planning. <h3>Findings</h3> Four hundred and seventy-four valid questionnaires were returned. Hierarchical multiple regression analyses revealed that the models of modified Measures of Public Preferences (<i>p</i> < .0001) were significant, with 22.7% of variance in facilitation, 81.9% of variance in content and 22.9% of variance in support being explained by variables at cultural, community, interpersonal and intrapersonal levels. The model of Advance Directives Attitude Survey (<i>p</i> < .0001) was significant with 25.6% of variance being explained by variables at cultural, community, interpersonal and intrapersonal levels. <h3>Discussion</h3> This study offers empirical evidence embedded within a social ecological perspective of the significance of cultural, social and contextual factors on individuals' preferences for EOL communication and healthcare planning. <h3>Conclusion</h3> Such information is important to enable health professionals to prepare individuals and their families for dealing with challenges related to EOL communication and healthcare.

Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults.

The purpose of this study was to examine the psychometric properties of the Advance Directive Attitude Survey in Korean (K-ADAS), a measure of attitudes toward advance directives (ADs). A total of 118 low-income, community-dwelling older adults (mean age, 75.09 years) participated. An exploratory factor analysis (EFA) was conducted to determine the factor structure of the K-ADAS. Validity was further assessed by known associations of the K-ADAS with perceived susceptibility and severity using part of the Advance Care Planning surveys. Its reliability was examined by calculating alpha coefficients. EFA determined a three-factor structure model with good model fit. Validity was further supported with significant correlations between the K-ADAS and susceptibility and severity. Reliability was supported by adequate level of Cronbach’s alpha. The K-ADAS was a valid and reliable measure for assessment of AD attitudes with a sound model fit. Thus, the K-ADAS can be used to assess AD attitudes among community-dwelling elders.

간호대학생의 웰다잉에 대한 인식, 사전연명의료의향서의 지식 및 태도가 임종간호태도에 미치는 영향

Purpose: This study was to explore the significant factors that influence attitudes toward end-of-life (EOL) care in nursing students. Methods: A total of 169 nursing students in four universities completed the self-reported questionnaires which included general characteristics, well-dying awareness, knowledge and attitude toward advance-directives, and attitudes toward EOL care. Results: The mean scores were 2.91±0.41 for well-dying perception, 6.61±2.13 for Advance Directives knowledge, 2.95±0.27 for Advance Directives attitudes, and 3.05±0.26 for EOL care attitudes. Factors affecting EOL care attitudes were analyzed by multiple regression. As a result, Advance Directives attitudes (β=.36, p<.001), major satisfaction (β=.30, p<.001), and experience of living with aged (β=.15, p=.014) were identified as factors affecting EOL care attitudes. The explanation power of this regression model was 37.0% and it was statistically significant (F=25.76, p<.001). Conclusion: Attitudes toward EOL care can be improved by establishing the positive attitudes toward ‘Advance Directives’ and building well-dying perception in nursing students.

Correlates of life-support treatment preferences among low-income home-based cancer management recipients.

To examine the correlates of life-support treatment (LST) preferences from attitudes toward advance directives (ADs), perceived susceptibility, symptom frequency, symptom burden, and global health among low-income community-dwelling cancer management recipients, controlling for age, sex, education, and duration after cancer diagnosis. A cross-sectional, correlational study design was used to assess LST preferences and correlates. Data were collected from low-income cancer survivors during nurses' home visits. Survivors who had mostly solid cancer participated (N = 107, mean age = 67.39 ± 11.57 years, 32.7% males). Hospice care was the most desired (66.4%), while aggressive treatments were less preferred: cardiopulmonary resuscitation (15.9%), ventilation support (15.0%), hemodialysis (18.7%), or chemotherapy (12.1%). Higher symptom frequency was associated with a greater likelihood of preferring all aggressive treatments (odds ratios = 1.44-1.75). In addition, longer cancer duration was associated with a greater likelihood of preferring ventilation support; females had a lesser likelihood of preferring hemodialysis and chemotherapy. Higher education was associated with a lesser likelihood of preferring chemotherapy. More positive attitudes (B = 0.15, p = .001) were associated with a greater likelihood of preferring hospice care, and greater symptom burden of pain (B = -0.03, p = .047) was associated with a lesser likelihood. Results support the feasibility of incorporating ADs into cancer management among community-dwelling cancer survivors, with consideration of AD attitudes and symptom monitoring. An integration of AD discussion into the home visiting service could be a liaison for the quality and continuity of cancer survivorship care that guides and manages patients' survivorship issues.

Development and Effect of Advance Directives Education Program for Nursing Students

본 연구는 간호대학생을 위한 사전연명의료의향서 교육 프로그램을 개발하고 적용하여 그 효과를 검정하고자 시도되었다. 연구 설계는 교육 프로그램을 적용 후 효과를 검정하기 위한 비동등성 대조군 전후설계를 이용한 유사 실험연구이다. 연구대상은 S시 소재 1개 대학의 간호학과 1.2학년 중 연구 목적을 이해하고 동의한 95명(실험군 48명, 대조군 47명)이다. 교육 프로그램은 50분씩. 2회, 총 100분으로 운영되었다. 내용은 특수/일반 연명의료와 사전연명의료의향서를 포함하고 있으며, 사례 기반 다양한 교수학습방법을 활용하여 진행하였다. 실험군의 사전조사는 교육 시작 30분전에 실시하였고, 사후조사는 교육 종료 2주 후에 실시하였다. 대조군의 사전, 사후조사는 실험군과 동일시점에 실시하였다. 자료 분석은 SPSS/Win 21.0을 이용하여 빈도와 백분율, 교차분석(chi-square test), Fisher s exact test, 독립표본 t-검정, 공분산분석(ANCOVA)을 이용하였다. 본 연구결과 연명의료 지식(F=36.755, p<.001), 연명의료중단 태도(F=5.666, p=.019), 사전연명의료의향서 지식(F=24.695, p<.001), 사전연명의료의향서 태도(F=4.893, p.=029) 및 인식이 대조군 대비 유의하게 증가 되었다. 본 연구결과를 토대로, 간호대학생들이 환자를 옹호하고 생명의 존엄성을 존중하는 역할을 수행하기 위해서는 연명의료제도에 대한 간호교육을 통하여 윤리적 가치관의 확립과 윤리적 핵심간호사역량 개발이 필요하다. 연명의료결정법이 좋은 법으로 인식되고 정착되기 위해서는 의료인들의 제도와 정책에 관심과 상담 및 교육자 역할이 활성화 되어야 한다.The purpose of this study was to develop and examine the effects of advance directives education program in nursing students. The study used a non-equivalent control group and pretest-posttest design. The study participants were 95 nursing students (48 in the experimental group and 47 in the control group) from one universities in S city. The contents of the training consisted of 100 minutes for two times for 50 minutes. The contents were composed of life-sustaining treatment and advance directives, and various teaching methods were used. Pretest were conducted 30 minutes before the intervention, posttest were 2 weeks after the training. The data were analyzed using chi-square test, Fisher’s exact test, independent t-test and ANCOVA using SPSS/WIN 21.0. There were significant increases in life-sustaining treatment knowledge (F=36.755, p<.001), withdrawing life-sustaining treatment attitude (F=5.666, p=.019), advance directives knowledge (F=24.695, p<.001), advance directives attitude (F=4.893, p.=029) and advance directives awareness in the experimental group. Based on the results of this study, in order for nursing students to play a role as mediators in advocating patients and respecting the dignity of life, nursing education on the advance directives requires the establishment of ethical values and the development of ethical core nursing competences.

The Impact of an Advance Care Planning Intervention for Patients with Heart Failure

Introduction Patients with chronic heart failure face a life-limiting disease trajectory, yet many have not addressed end-of-life planning. The ideal method to assist patients with advance directive (AD) completion and end-of-life goal setting is not clearly established. Hypothesis: A nurse practitioner led, interactive education program for patients hospitalized with acute decompensated heart failure utilizing the Institute of Healthcare Improvement tool, The Conversation Project, will improve patient attitudes regarding advance directives, increase completion of advance directive documents and increase discussion of end-of-life goals with significant others and health care providers. Methods A convenience sample of 30 patients hospitalized with acute decompensated heart failure who had not completed AD was used. Study participants completed the Advance Directive Attitude Survey (ADAS) prior to reviewing The Conversation Project materials and receiving education from a nurse practitioner trained in end-of-life counseling. A comparison of pre-/post-intervention outcome measures included ADAS scores, completion of AD, establishment of surrogate decision maker and discussion of end-of-life goals with provider and significant others. Results All study participants (n=30) had positive ADAS scores prior to the intervention. Post intervention outcomes were measured 30 days after the intervention in 25 participants (83%). ADAS scores remained positive with no significant change (p=0.53). A noteworthy 64% (n=16) of participants discussed AD with significant other, 40% (n=10) established surrogate decision maker and 28% (n=7) completed AD. Only 12% (n=3) discussed AD with a health care provider. Conclusions A nurse practitioner led advance care planning program using The Conversation Project showed clinically significant, but limited outcome improvement. A positive attitude regarding AD was not associated with completion of AD documents or discussion of end-of-life goals with significant others or health care providers. Further study of measures to improve the AD completion process, including programs targeting the outpatient population over a longer time frame and strategies to increase discussion with health care providers is recommended.

노인환자의 사전의료의향서 태도 결정에 영향을 미치는 가족기능과 자기효능감 요인

본 연구는 노인환자의 사전의료의향서에 대한 태도를 결정하는데 영향을 주는 요인을 파악하기 위해 충남 소재 요양병원 5곳과 종합병원 1곳에 입원한 65세 이상의 노인 환자를 대상으로 조화된 설문지를 이용하여 조사하였 다. 사전의료의향서에 대한 태도는 2.84점으로 평균이상 수준, 가족기능은 2.73점으로 평균 이하의 수준이었으며, 자 기효능감은 3.45점으로 평균 이상의 수준이었다. 연구 결과, 가족기능이 좋을수록 사전의료의향서에 대한 태도가 부 정적(r=.-.324, p<.01)이었으며, 자기효능감이 좋을수록 사전의료의향서에 대한 태도가 긍정적인 것으로 나타났다 (r=.340, p<.01). 본 연구는 사전의료의향서가 국내에 정착하는데 기여할 것이다.

Relationship of social support and decisional conflict to advance directives attitude in Korean older adults: A community‐based cross‐sectional study

The aim of this study was to clarify the relationship between social support, decisional conflict, and attitude towards advance directives, and determine whether decisional conflict mediates the relation between social support and advance directives attitude among older adults in South Korea. In total, 209 community-based older adults (mean age, 74.82 years) participated in this cross-sectional study. Demographic characteristics, self-perceived health status, social support, decisional conflict, and advance directives attitude were investigated via a structured questionnaire. Data analysis was carried out using Pearson's correlation and path analyses. The mean score of advance directives attitude was 48.01 (range, 35-61). Decisional conflict and social support were both significantly related to advance directives attitude (P < 0.001). Additionally, decisional conflict was a mediator between social support and advance directives attitudes. The results confirmed the importance of social support for reducing decisional conflict and encouraging positive attitudes toward advance directives. Future studies are needed to support the development of culturally sensitive educational approaches regarding advance directives for older adults in Korea.

Factors Influencing Attitude toward Advance Directives of Older Cancer Patients

Purpose: The aims of this study were to identify the reported attitudes of older patients with cancer toward advance directives (ADs) and the factors associated with their attitudes toward ADs. Methods: The design was a cross-sectional survey. The age mean of the 130 participants were 70.8, and 66.2% of the participants were male. The data were collected at one university hospital in Seoul, South Korea during the period from October 1 to December 5 in 2013. The data collecting instruments were the Advance Directives Attitude Survey (ADAS) and questionnaires including socio-demographic and disease-related characteristics, family function. Results: 30.0% of the participants were aware of ADs, only 9% of them had been informed by healthcare providers. Most participants (93.1%) intended to complete ADs. The mean score of ADAS was 48.29. The stepwise linear regression analysis indicated that family function, perceived health status, period of education, and age accounted for a significant percentage (52.0%, p<.001) of the variance in participants’ ADAS. The variable with the greatest effect was family function. Conclusion: The findings suggest that family function and attitude of older cancer patients need to be considered for adapting ADs to Korean health care systems. Healthcare providers should include family members in advanced care planning discussions.

Do unto others: doctors' personal end-of-life resuscitation preferences and their attitudes toward advance directives.

ObjectiveHigh-intensity interventions are provided to seriously-ill patients in the last months of life by medical sub-specialists. This study was undertaken to determine if doctors' age, ethnicity, medical sub-specialty and personal resuscitation and organ donation preferences influenced their attitudes toward Advance Directives (AD) and to compare a cohort of 2013 doctors to a 1989 (one year before the Patient Self Determination Act in 1990) cohort to determine any changes in attitudes towards AD in the past 23 years.DesignDoctors in two academic medical centers participated in an AD simulation and attitudes survey in 2013 and their responses were compared to a cohort of doctors in 1989.OutcomesResuscitation and organ donation preferences (2013 cohort) and attitudes toward AD (1989 and 2013 cohorts).ResultsIn 2013, 1081 (94.2%) doctors of the 1147 approached participated. Compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD (p<0.001, AUC = 0.77); had greater confidence in their treatment decisions if guided by an AD (p<.001, AUC = 0.58) and were less worried about legal consequences of limiting treatment when following an AD (p<.001, AUC = 0.57). The gender (p = 0.00172), ethnicity (χ2 14.68, DF = 3,p = .0021) and sub-specialty (χ2 28.92, p = .004, DF = 12) influenced their attitudes towards AD. 88.3% doctors chose do-not-resuscitate status and wanted to become organ donors. Those less supportive of AD were more likely to opt for “full code” even if terminally ill and were less supportive of organ donation.ConclusionsDoctors' attitudes towards AD has not changed significantly in the past 23 years. Doctors' gender, ethnicity and sub-specialty influence their attitudes towards AD. Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.

Advance Directives, Control, and Quality of Life for Persons with Disabilities

Personal control over end-of-life (EOL) care via advance care planning is a key component of high-quality care. Although this desire for control has been well documented in some populations, EOL care issues are not well understood within the disabilities community. The objective for this study was to describe the relationships between individual demographic characteristics, health-related quality of life, health locus of control, and attitudes toward advance directives (ADs) in individuals who are disabilities activists. We surveyed 55 participants attending a disability conference. Instruments included a demographic data sheet, the Advance Directive Attitude Survey (ADAS), the Multidimensional Health Locus of Control scale, and the Functional Assessment of Non-Life Threatening Conditions quality of life (QOL) scale. Most participants were Hispanic females with some college education. About 46% had a disability. Group means revealed a high level of QOL (M=75.72, SD=19.09) and a positive attitude about ADs (M=66.49, SD=8.03). On the Opportunities for Treatment Choices subscale of the ADAS, activists without disabilities (M=14.23) were more positive about their control over EOL decisions than were the activists with disabilities (M=12.97) [t(2,52)=2.116, p<0.05]. Although participants were positive about ADs, differences in attitudes about control over opportunities for treatment choices between the nondisabled and disabled groups support previous findings that people with disabilities may have concerns regarding undertreatment for serious health conditions. Further study of EOL care issues for persons with disabilities is warranted.