Advance Directives and Factors Associated with the Completion in Patients with Heart Failure

Abstract

Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred (n = 15) followed by avoiding family burden (n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults

“…We separately controlled for a history of any cancer (excluding skin cancer) because individuals with a cancer diagnosis are more likely to complete an advance directive than those without (Park et al, 2015). Finally, we controlled for difficulties with Activities of Daily Living (e.g., bathing or dressing; range 0–5) or Instrumental Activities of Daily Living (e.g., handling money or taking medication; range 0–5) because individuals with poorer functional status have previously been more likely to complete ACP (Hansen et al, 2019; Kim et al, 2021).…”

Psychometric Properties of the Advance Care Planning Engagement Survey-9 in Cardiovascular and Metabolic Diseases

“…The implementation of ACP in Korean patients with CVDs or MetS was suboptimal. At least 2 of 3 Korean patients with CVDs or MetS in this study heard about ADs, but only 1 of 3 registered ADs, which is similar to 34% completion of ADs in patients with heart failure in the United States 11 but lower than that in Korean patients with heart failure (52.2%) 27 . In this study, one promising fact is that most of the patients had the intention to register for ADs.…”

“…Item Analysis, Internal Consistency, and Factor Loading of the Korean Version of the Advance Care Planning Engagement Survey-9Cronbach α for the total scale is .93. completion of ADs in patients with heart failure in the United States11 but lower than that in Korean patients with heart failure (52.2%) 27. In this study, one promising fact is that most of the patients had the intention to register for ADs.…”

Voluntades anticipadas como referente ético de conocimiento en los enfermeros que laboran en servicios de oncología

“…Al respecto, Graw (51) identificó que solo el 12.8% de las personas que asistieron a una sala de emergencias por trauma en Alemania tenían elaborado y firmado un Documento de Voluntad Anticipada. En Corea del Sur, Kim et al (52) determinaron que solo el 52% de los pacientes con falla cardíaca pertenecientes a un programa de seguimiento y control habían diligenciado este documento. Por otra parte, en China, Wang (53) estableció que solo el 14% de personas adultas mayores había completado un documento de este tipo.…”