Attitudes and beliefs towards advance directives and end-of-life care preferences among elderly population in a community health centre

Cuevas García, Julia; Gil Caravaca, Verónica; Osuna Carrillo de Albornoz, Eduardo

doi:10.1016/j.medcle.2022.11.004

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AHD: advance healthcare directive." ] ] ] "textoCompleto" => "Today, increasing life expectancy and population ageing have led to an increase in chronic diseases. These diseases often lead to functional impairment, vulnerability and dependency in the population, raising major questions in medical practice.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The advance health care directive (AHD) guarantees the patient's prospective decision-making on his or her own health,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> however, its formalisation in the general population is rare.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In order to find out the opinions and preferences of older patients regarding knowledge, attitude and consent of the AHD document, an observational, descriptive and cross-sectional study was conducted. Patients ≥ 65 years of age in primary care who were administered a survey were included; those with terminal illness or cognitive impairment were excluded. The sample size was calculated by simple random sampling, estimating 168 subjects. The study complied with research standards and was approved by the Ethics Committee of the University of Murcia (ID: 2735/2020).We obtained a response rate of 93.45% (n=156). The mean age was 76.0±0.6 years, 55.1% were women, 86.5% Catholics, 26.3% had no schooling, and 68.6% had previously acted as caregivers for people with serious illnesses.Of those surveyed, 39.1% reported having thought about end-of-life care only sometimes and 34.6% often. We observed that the degree of consideration about caregiving increased in women (χ2=10.576; p=0.005) and in former caregivers (χ2=4.029; p=0.045). Of the patients, 63.5% had had end-of-life discussions, mostly with a family member (57.7%) and 0.6% with healthcare professionals.Among the subjects, 52.6% were unaware of the AHD document and only 5% had registered it. Certain factors are related to a more favourable attitude towards the formalisation of an AHD.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In this sense, we found a greater predisposition to register the AHD document in women (χ2=3. 662; p=0.050) and in subjects aged 65–74 (χ2=6.431; p=0.040). In addition, the number of times care work had been carried out for others was also associated with a more favourable attitude towards completing the AHD document (Mann-Whitney U=2071.5; p=0.005).In our study, 71.8% of the subjects stated that end-of-life decisions should be made by the patient, 28.2% by relatives and 19.2% exclusively by the physician.Also, the majority of the sample (76.3%) was willing to discuss these issues with the family doctor, but it was striking that, less than 50% of these subjects would complete this process by actually registering the AHD document (χ2=16.661; p=0.000) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These results are in line with other recent research.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>In conclusion, the population analysed shows a willingness to express their preferences regarding end-of-life care, but the AHD document is not reported as the means of choice. This is due, on the one hand, to the public's lack of awareness of their existence and, on the other hand, to patients' preference for humane rather than bureaucratic treatment.The experience of having provided care triggers reflections on the end of life and leads to the communication of these reflections, generating a greater willingness to formalise preferences through the AHD document. Women are more involved in this process because of the gender role they have traditionally played as caregivers.Finally, there is evidence that patients want to take the lead in making decisions about their own care and want to discuss this with their doctor, even if these discussions take place very occasionally. From this arises the need for further research in order to implement communication tools in health clinics, based on accompaniment and active listening, which encourage and trigger a shared deliberative process between the patient, family members and health professionals.FundingThis research has not received specific support from public sector agencies, commercial or non-profit organisations.Conflict of interestsNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 944 "Ancho" => 1675 "Tamanyo" => 82486 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Column chart: bivariate analysis between willingness to talk to the doctor about care and attitude towards the AHD document. AHD: advance healthcare directive." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medicina geriátrica. Una aproximación basada en problemas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Abizanda Soler" 1 => "C. Cano Gutiérrez" 2 => "R.A. Heredia Ramírez" 3 => "M. León Ortiz" 4 => "E. Martín Sebastiá" 5 => "L. Romero Rizos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "2nd ed" "fecha" => "2020" "editorial" => "Elsevier" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspectos éticos de la atención de anestesia. Miller. Anestesia. [Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V.N. Van Norman" 1 => "S.H. Rosenbaum" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "9o ed" "fecha" => "2021" "paginaInicial" => "231" "paginaFinal" => "248" "editorial" => "Elsevier" "editorialLocalizacion" => "España" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.clinicalkey.es/#!/content/book/3-s2.0-B9788491137368000089?scrollTo=%23hl0000414" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Registro Español de Directivas Anticipadas. [Internet]. [Accessed 3 April 2021]. Available from: <a target="_blank" href="https://www.sanidad.gob.es/ciudadanos/rnip/doc/Documentos_2021/Octubre_2021/Declarantes_con_Instruccion_Previa_Activa_por_Comunidad_Autonoma_y_grupos_de_edad-Octubre_2021.pdf">https://www.sanidad.gob.es/ciudadanos/rnip/doc/Documentos_2021/Octubre_2021/Declarantes_con_Instruccion_Previa_Activa_por_Comunidad_Autonoma_y_grupos_de_edad-Octubre_2021.pdf</a>." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploring advance care planning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Rodi" 1 => "K. Detering" 2 => "M. Sellars" 3 => "A. Macleod" 4 => "J. Todd" 5 => "S. Fullerton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00520-020-05878-z" "Revista" => array:6 [ "tituloSerie" => "Support Care Cancer [Internet]" "fecha" => "2021" "volumen" => "29" "paginaInicial" => "3677" "paginaFinal" => "3688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33184712" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "End-of-life care preferences of older patients with multimorbidity: a mixed methods systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.I. González-González" 1 => "C. Schmucker" 2 => "J. Nothacker" 3 => "E. Nury" 4 => "T.S. Dinh" 5 => "M.S. Brueckle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Clin Med" "fecha" => "2020" "volumen" => "10" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000005/v1_202303052139/S2387020623000578/v1_202303052139/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000005/v1_202303052139/S2387020623000578/v1_202303052139/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000578?idApp=UINPBA00004N"]

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Vol. 160. Issue 5.

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