An Update on Advance Directives in the Medical Record: Findings from 1186 Consecutive Patients with Unresectable Exocrine Pancreas Cancer

Tan, Tow Shung; Jatoi, Aminah

doi:10.1007/s12029-008-9041-z

Cited by 17 publications

(24 citation statements)

References 13 publications

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“…This was consistent with previous studies [11, 21, 33, 35]. Usually, the older cancer patients talk about the death much more than the younger patients, and most of them desire for death with dignity, but they are not sure how to die, therefore, they willing to use ADs to put their wishes on paper.…”

Section: Discussionsupporting

confidence: 91%

“…Previous studies indicate that completion of ADs was 15 to 41 % among the cancer patients [11, 20, 21]; 9 to 70 % among older adults [2, 5, 16, 22]; 15 to 30 % among general population [23]; 7 % among hemodialysis patients [24]; 6 % among hematological malignancy patients [25]. Dow reported that 63 % of oncology patients did not know what an AD was [11], and Ewer doubted about the purpose and role of ADs [26].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies showed that use of ADs was associated with sociodemographic characteristics [2, 21, 27–30]. Previous studies have found that persons with ADs documents were more likely to die at home than in a hospital [2, 18].…”

Section: Introductionmentioning

confidence: 99%

“…Absence of ADs can lead to unwanted aggressive medical care while patients lacking decision-making capacity [2, 31]. Tan et al reported that older people and having cancer therapy were more likely to have an AD [21]. It was reported that older age [11, 30] and health insurance [30] were associated with a greater likelihood of ADs completion.…”

Section: Introductionmentioning

confidence: 99%

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Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China

Zheng

Xiang

et al. 2016

Support Care Cancer

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Purpose Many cancer patients do not have advance directives (ADs), which may lead to unwanted excessive or aggressive care when patients have lost decision-making capacity. The aim of this study was to investigate knowledge and attitudes of approving ADs and explore factors associated with willing to designate ADs among cancer patients in China. Methods We conducted semi-structured interview method investigating 753 in-patients with cancer in two cancer centers. Results Of those subjects, none of the cancer patients had an AD. Only 22.4 % (118 of 526) approved ADs. Comparing with the disapproved ADs group, the approved ADs group were more likely to discuss the AD with oncologist or nurse (χ 2 = 180.4, p < 0.001) in the cancer center (χ 2 = 244.1, p < 0.001), and they chose more comfort care (χ 2 = 18.8, p < 0.001). Most of cancer patients in the two groups wanted to die at home (72.8 %, 73.7 %, respectively). The older patients (OR, 1.04, 95 % CI, 1.02-1.07, p = 0.001), female (OR, 0.55, 95 % CI, 0.35-0.88, p = 0.013), with higher education levels (OR, 3.38, 95 % CI, 1.92-5.96, p < 0.001), with religious beliefs (OR, 2.91, 95 % CI, 1.71-4.94, p < 0.001), and with higher scores of ECOG (OR, 1.46, 95 % CI, 1.17-1.82, p = 0.001) were associated with desiring for ADs. Conclusions Our findings indicate that there was a dearth of knowledge and different attitudes toward approving ADs among cancer patients, and some factors of demographic and clinical characteristics influenced their willing to designate ADs. This research highlights the importance of propagandizing the ADs to the public, especially to the patients, and further discussing with them when the time is ripe.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China

Zheng

Xiang

et al. 2016

Support Care Cancer

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“…31 This is also consistent with a cohort of 1186 consecutive advanced pancreas cancer patients at the Mayo Clinic, wherein only 15% had an AD as part of the medical record. 32 One additional indication of patient wishes in the video arm (or one fewer in the narrative arm) would have made for statistical significance in our study.…”

Section: Epstein Et Almentioning

confidence: 94%

A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients

Epstein

Volandes

Chen

et al. 2013

Journal of Palliative Medicine

121

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Background: Cardiopulmonary resuscitation (CPR) is an important advance directive (AD) topic in patients with progressive cancer; however such discussions are challenging. Objective: This study investigates whether video educational information about CPR engenders broader advance care planning (ACP) discourse. Methods: Patients with progressive pancreas or hepatobiliary cancer were randomized to an educational CPR video or a similar CPR narrative. The primary end-point was the difference in ACP documentation one month posttest between arms. Secondary end-points included study impressions; pre-and post-intervention knowledge of and preferences for CPR and mechanical ventilation; and longitudinal patient outcomes. Results: Fifty-six subjects were consented and analyzed. Rates of ACP documentation (either formal ADs or documented discussions) were 40% in the video arm (12/30) compared to 15% in the narrative arm (4/26), OR = 3.6 [95% CI: 0.9-18.0], p = 0.07. Post-intervention knowledge was higher in both arms. Posttest, preferences for CPR had changed in the video arm but not in the narrative arm. Preferences regarding mechanical ventilation did not change in either arm. The majority of subjects in both arms reported the information as helpful and comfortable to discuss, and they recommended it to others. More deaths occurred in the video arm compared to the narrative arm, and more subjects died in hospice settings in the video arm. Conclusions: This pilot randomized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects. This trend, as well as other video effects, is the subject of ongoing study.

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What Are the Patient’s Wishes?

Feblowitz

Richards

2015

JAMA Intern Med

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An Update on Advance Directives in the Medical Record: Findings from 1186 Consecutive Patients with Unresectable Exocrine Pancreas Cancer

Abstract: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.

Cited by 17 publications

References 13 publications

Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China

Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China

A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients

What Are the Patient’s Wishes?

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