Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

Park

et al. 2020

IJERPH

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Deactivation of an implantable cardioverter-defibrillator (ICD) is a critical issue in the advance care planning (ACP) of ICD recipients; however, related perspectives have rarely been explored. Thus, this study aimed to provide an initial investigation of ICD recipients’ perceived susceptibility and barriers/benefits regarding ACP and/or advance directives (ADs), and associations of these modifiable factors with preferences for end-of-life life-sustaining treatments (LSTs) (cardiopulmonary resuscitation (CPR), ventilator support, hemodialysis, and hospice care). Using a descriptive correlational design, 48 ICD recipients (age, 50.1 years; male, 85.4%) completed survey questionnaires. “No burden on family” was the most highly valued (59.1%), followed by “comfortable death” (20.4%), and both (11.4%). LST preference was 43.8% for ventilator support, 45.8% for both hemodialysis and hospice care, and 54.2% for CPR. Perceived susceptibility to having unexpected end-of-life experiences increased the likelihood of preference for aggressive LSTs, with preferences increasing by 15% for CPR, 17% for ventilator support, and 23% for hemodialysis. A non-modifiable factor, older age, was the only predictor of increased preference for hospice care (odds ratio = 1.09, p = 0.016). Among the modifiable factors, a higher perceived susceptibility increased the likelihood of aggressive LST preferences. The findings imply that to facilitate informed decisions for LSTs, early ACP discussion could be helpful and enhance these modifiable factors.

Section: Discussionmentioning

confidence: 84%

Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators

Park

et al. 2020

IJERPH

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“…The non-awareness of ADs in the majority of patients with HF may be one reason for this lack of a significant relationship given the lack of variability in knowledge. In a pilot study, patients with HF reported knowledge deficit as a major reason for incomplete K-AD survey [ 41 ]. Thus, further research is warranted to examine this relationship in larger sample studies with more variability in knowledge.…”

Section: Discussionmentioning

confidence: 99%

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

Shin

et al. 2021

IJERPH

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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.

“…In addition to the associational relationships of the diagnostic contexts with EoL treatment preferences, we also examined possible associations of AD attitudes and perceived susceptibility with EoL treatment preferences because prior studies showed possible associations of AD attitudes and perceptions with an individual's decisions for the desired EoL treatments [26][27][28][29]43]. However, little is known about these links.…”

Section: Plos Onementioning

confidence: 99%

“…Based on several prior studies that reported substantial burdens of care [10,11,13] and demands for future EoL care planning [12,13], but less access to ACP in patients with HF [12,24] compared to the cancer population [12], this study hypothesized that diagnostic contexts (non-cancer HF vs. cancer) would be associated with consideration of an AD with primary decision-making for LST options, such as cardiopulmonary resuscitation (CPR) [10,24]. In addition, such a decision may be influenced by some modifying factors, such as attitudes toward ADs [26,27] and perceived susceptibility to AD use [28,29]. We also hypothesize that a person with more positive attitudes and greater perceived importance for having unexpected EoL experiences without an AD is more likely to consider an AD.…”

Section: Introductionmentioning

confidence: 99%

Do advance directive attitudes and perceived susceptibility and end-of-life life-sustaining treatment preferences between patients with heart failure and cancer differ?

et al. 2020

Self Cite

There is limited evidence on the relationships of preference for end-of-life life-sustaining treatments [LSTs] and diagnostic contexts like heart failure [HF] or cancer, and patient attitudes toward and perceived susceptibility to use advance directives [ADs]. Thus, this study aimed to compare attitudes and perceived susceptibility between HF patients and community-dwelling patients with cancer, and examine the associations of these variables with their preference for each LST (cardiopulmonary resuscitation [CPR], ventilation support, hemodialysis, and hospice care). Secondary data were obtained from 36 outpatients with HF (mean age, 65.44 years; male, 69.4%) and 107 cancer patients (mean age, 67.39 years; male, 32.7%). More patients with HF preferred CPR than cancer patients (41.7% and 15.9%, χ 2 = 8.88, P = 0.003). Attitudes and perceived susceptibility were similar between the two diagnostic cohorts. HF patients and those with more positive attitudes had greater odds of preferring CPR (odds ratio [OR] = 3.02, confidence interval [CI] = 1.19, 7.70) and hospice care (OR = 1.14, CI = 1.06, 1.23), respectively. HF diagnosis and AD attitudes increased the preference for CPR and hospice care, respectively. This suggests that it is important to gain positive attitudes toward ADs and consider diagnostic context to facilitate informed decision-making for LSTs.