Experience of Advance Directives in a Hospice Center

Abstract

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.Graphical Abstract

Advance directives of lung cancer patients and caregivers in China: A cross sectional survey

“…The survival or mortality rate can be different in a wide range of diseases, and therefore patients may have different confidence in overcoming the disease. Furthermore, contrary to our study, in the study by Kong et al . most terminal cancer patients did not want to receive any invasive medical interventions to sustain life.…”

“…In Germany, 18% of cancer patients, 19% of healthy people, and 28%–31% hematology and oncology outpatient patients had signed ADs . In Korea, 35.5% of patients in a Hospice Center completed ADs, and in the report by White et al . 14% of the Australian population had ADs .…”

“…The overall AD preparation rate is low. Previous studies have indicated that completion of ADs was 14%–30% among the general population, and 15%–49% among cancer patients . Many factors are associated with having ADs including sociodemographic characteristics such as age, level of education, gender, religious beliefs, health or functional status, public education on ADs, and traditional perspectives .…”

Discussions about palliative sedation in hospice: Frequency, timing and factors associated with patient involvement

“…In particular, palliative sedation may be introduced during a palliative care advance care planning, in order to help patients and their family members to understand what palliative sedation is and to express their opinions and possible concerns with regard to this practice. Although several studies showed that most patients with cancer preferred the use of palliative sedation (Kong, An, & Kim, ; Miccinesi, Bianchi, Brunelli, & Borreani, ; Pautex, Notaridis, Déramé, & Zulian, ), there are patients who might prefer to die in a state of consciousness (Miccinesi et al, ). In addition, since advance care planning discussions “should match how ready the person is to talk about her or his medical care” (Sudore et al, ), the adaptation of advance care planning according to the readiness of the individual is recommended (Rietjens et al, ).…”

“…Although several studies showed that most patients with cancer preferred the use of palliative sedation (Kong, An, & Kim, 2015;Miccinesi, Bianchi, Brunelli, & Borreani, 2012;Pautex, Notaridis, Déramé, & Zulian, 2010), there are patients who might prefer to die in a state of consciousness . In addition, since advance care planning discussions "should match how ready the person is to talk about her or his medical care" , the adaptation of advance care planning according to the readiness of the individual is recommended .…”