Cancer Patients and Advance Directives: A Survey of Patients in a Hematology and Oncology Outpatient Clinic

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Abstract

Background: In 2009, Germany enacted a new law supporting advance directives that led to heated discussions in the media and the public. 3 years after the law passed, we surveyed patients with malignant diseases with regards to their views on advance directives. Patients and Methods: Between September 2011 and July 2012 an anonymous survey on advance directives was conducted among 617 patients at the hematology and oncology outpatient department of the University Hospital Mannheim, using a standardized questionnaire developed for this investigation. Results: Of the 503 patients who returned the questionnaire, 31% (n = 157) indicated having an advance directive. Of these 157, 54% (n = 85) completed the advance directive after 2009. 56% (282 out of 503) desired more information on advance directives. Of these, 71% (201 out of 282) wanted their general physician and 45% (128 out of 282) their specialist, to provide more information about this issue. Of the 339 patients without an advance directive, 47% (n = 158) stated that they had ‘not worried about that yet'. Conclusion: Although the percentage of patients with advance directives has increased since the legislative amendment, more information is still required by patients. It is recommended that physicians should discuss advance directives more frequently with their patients.

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Factors influencing older adults to complete advance directives.

Paul Wolf, J Alano, Martin Lesser … (2010)

The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults. Direct interviews of hospitalized and community-dwelling cognitively intact patients > 65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables. Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76-85 vs. 59-75: OR 3.4, p < 0.0543; < 85 vs. 59-75: OR 6.3, p < 0.0263). This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.

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Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff.

S Sahm, R Will, G Hommel (2005)

After years of public discussion too little is still known about willingness to accept the idea of writing an advance directive among various groups of people in EU countries. We investigated knowledge about and willingness to accept such a directive in cancer patients, healthy controls, physicians, and nursing staff in Germany. Cancer patients, healthy controls, nursing staff, and physicians (n = 100 in each group) were surveyed by means of a structured questionnaire. Only 18% and 19% of the patients and healthy controls respectively, and 10% of the medical staff had written an advance directive. However, 50-81% of those surveyed indicated that they wished to write one. This intention was associated with deteriorating health (p < 0.001). Only 29% of the healthy controls and 43% of the patients knew about the possibility of appointing a health care proxy. A majority in all groups believed that advance directives may influence the course of treatment (79-85%), yet half of those surveyed in all groups fear that patients could be pressurised into writing an advance directive, and 38-65% thought that relatives could abuse such documents. Only a minority of the participants had written an advance directive and knew about the possibility of authorizing a health care proxy. Deteriorating health was associated with increasing willingness to make a directive. Despite a majority belief that advance directives may influence treatment at the end of life, other factors limit their employment, such as fear of abuse.

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Advance directives: prevalence and attitudes of cancer patients receiving radiotherapy.

Birgitt van Oorschot, Michael Schuler, Alfred Simon … (2012)

Advance directives (AD) are becoming increasingly widespread. We examine the prevalence of AD and the factors associated with AD in tumor patients during radiotherapy.

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Journal

Journal ID (publisher-id): ONK

Journal ID (nlm-ta): Oncol Res Treat

Journal ID (doi): 10.1159/issn.2296-5270

Title: Oncology Research and Treatment

Publisher: S. Karger AG

ISSN (Print): 2296-5270

ISSN (Electronic): 2296-5262

Publication date Subscription-year: 2013

Publication date (Print): August 2013

Publication date (Electronic): 08 July 2013

Volume: 36

Issue: 7-8

Pages: 398-402

Affiliations

^aIII. Medizinische Klinik, ^bII. Medizinische Klinik, ^cKlinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Mannheim, Universität Heidelberg, ^dHubertus Wald Tumorzentrum, Universitäres Cancer Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, ^eSTABIL, Zweibrücken, Germany

Article

Publisher ID: 353604 Other ID: Onkologie 2013;36:398–402

DOI: 10.1159/000353604

PubMed ID: 23921757

SO-VID: d4bac0cb-1864-481f-bdb9-99a0e0660c03

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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Cancer Patients and Advance Directives: A Survey of Patients in a Hematology and Oncology Outpatient Clinic

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Karger: Oncology

Most cited references 15

Factors influencing older adults to complete advance directives.

Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff.

Advance directives: prevalence and attitudes of cancer patients receiving radiotherapy.

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