Effect of the Contents in Advance Directives on Individuals’ Decision-Making

Abstract

<jats:p> Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded “accept the special interventions” on the reference form. However, the majority (70%–90%) chose “refuse the interventions” on the negative form. With respect to the religious form, 70% to 80% chose “not decided yet.” Participants who refused special life-sustaining treatments were older, female, and with better prior knowledge about advance directives. Our findings imply that the specific content of advance directives could affect decision-making with regard to various interventions for end-of-life care. </jats:p>

Factors Influencing Older Adults' End-of-Life Care Preferences

“…By contrast, men tend to follow professionals' opinions and accept aggressive treatments than women 26 . This phenomenon may be related to traditional gender roles and social expectations 24 …”

“…Previous studies on older adults have shown that sex affects their perceptions of EOL care. 3,[21][22][23][24][25] One study indicated that women were more likely to refuse special life-sustaining treatment, such as CPR and ventilator, than men. 24 Another study in Switzerland showed that women had higher AD awareness and completion levels than men.…”

“…26 This phenomenon may be related to traditional gender roles and social expectations. 24 Older adults' independence is related to their EOL care. In this study, the participants' hope for independence and concerns about burdening their family members were significantly and negatively correlated with their total LSPQ scores.…”

“…Compared with men, women had low overall LSPQ scores and tended to avoid antibiotics, CPR, surgery, and nasogastric tube feeding. Previous studies on older adults have shown that sex affects their perceptions of EOL care 3,21-25 . One study indicated that women were more likely to refuse special life-sustaining treatment, such as CPR and ventilator, than men 24 .…”

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

“…En concordancia con lo dicho, Toro et al recomiendan que los profesionales sanitarios "mejoren su conocimiento sobre este tema para poder ayudar a sus pacientes a hacer realidad sus instrucciones previas" (13, p. 406), puesto que el contenido del dva puede tener repercusiones en la toma de decisiones frente a esta práctica. Así lo demostraron Park et al (46) en su estudio acerca del efecto del contenido del dva en la toma de decisiones individuales frente al mismo; un alto porcentaje de participantes rechazaron las opciones de va expresadas en el documento cuando estas fueron expresadas en términos negativos. Mientras que otro porcentaje de participantes presentó un alto grado de indecisión a causa de los términos religiosos incluidos en el dva.…”