Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Abstract

BackgroundThis paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals’ understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania.MethodsA cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods.ResultsThe analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents’ profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice.Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives.ConclusionsThe study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD’s improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

Terminalidade e testamento vital: o conhecimento de estudantes de medicina

“…This large difference can be associated to the curricular approach of the courses. The results are similar to those of the present study: only 24.6% of physicians fully understand the definition of AWD 17 . In other studies, there is also a lack of knowledge about the subject in the population as a whole: 94,5% of patients did not know anything about LW 13 .…”

Attitudes, Perceptions, and Experiences toward End-of-Life Care Decision-Making among Intensive Care Unit Nurses in Korea : An Integrative Review

“…중환자실의 경우, 사망가능성이 높은 환자의 입실로 연명의료의 시작이나 중단 등과 관련하여 환자나 보호자 등이 의사결정해야 하는 상황이 빈번하게 발생된다 (Coffey et al, 2016;. 실제로 중환자실에 입원하는 환자 의 약 6~11%가 연명의료를 받고 있고, 중환자실에서 발생하는 사망의 50~90%가 연명의료 중단과 관련이 있다고 알려져 있다 (Opgenorth et al, 2018 (Moon, 2015;Myburgh et al, 2016;Peicius, Blazeviciene, & Kaminskas, 2017). 중환자실은 주로, 급성 중증 환자들을 치료하는데 목 적을 두고 있으며, 고도의 기술적, 치료적인 관점에 중 점을 두고 있어 생애말 환자간호에 대한 관심은 상대적 으로 부족한 실정이다 Moon, 2015 (Chan et al, 2019;Jimenez et al, 2018;Saloron, Ramos, Schnelder, da Silveira, & Silveira, 2017;Vuong, Kittelson, McCullough, Yingwei, & Hartjes, 2019 (Han, Chung, Moon, Han, & Ko, 2001 [18]; Bae et al, 2009 [A14]; Revised by author [A4])…”

Are older adults’ demographic characteristics social determinants of their perceived importance, desire, and ability to perform end‐of‐life self‐care actions?

“…Care planning for EOL is a means to bridge gaps in health care delivery and empower self-determination and promotion of self-care actions among patients. 12,13 The estimated percentage of older adults who have executed an advance directive has been estimated at between 55% and 60% for older adults who reside in the community. 14 A compelling reason explaining this fairly low percentage is the low levels of knowledge of EOL care plans among older adult populations and health care providers.…”

“…14 A compelling reason explaining this fairly low percentage is the low levels of knowledge of EOL care plans among older adult populations and health care providers. 12,15,16 Limited studies have examined older adults' perceptions of selfcare actions related to EOL planning for its importance level and their desire and ability to perform these actions. 4,5,17 One recent US study found that adults' perceptions of self-care actions are associated with their self-reported health outcome (ie, emergency room use in the past 3 months).…”

“…The estimated percentage of older adults who have executed an advance directive has been estimated at between 55% and 60% for older adults who reside in the community . A compelling reason explaining this fairly low percentage is the low levels of knowledge of EOL care plans among older adult populations and health care providers …”