TY  - JOUR
A1  - Schröder, Lars
A1  - Homme, Gerhard
A1  - Sahm, Stephan
T1  - Intricate decision making : ambivalences and barriers when fulfilling an advance directive
T2  - Patient preference and adherence
N2  - Background: Despite a recent statutory ruling stating the binding nature of advance directives (ADs), only a minority of the population has signed one. Yet, a majority deem it of utmost importance to ensure their wishes are followed through in case they are no longer able to decide. The reasons for this discrepancy have not yet been investigated sufficiently.
Patients and methods: This article is based on a survey of patients using a well-established structured questionnaire. First, patients were asked about their attitudes with respect to six therapeutic options at the end of life: intravenous fluids, artificial feeding, antibiotics, analgesia, chemotherapy/dialysis, and artificial ventilation; and second, they were asked about the negative effects related to the idea of ADs surveying their apprehensions: coercion to fulfill an AD, dictatorial reading of what had been laid down, and abuse of ADs.
Results: A total of 1,260 interviewees completed the questionnaires. A significant percentage of interviewees were indecisive with respect to therapeutic options, ranging from 25% (analgesia) to 45% (artificial feeding). There was no connection to health status. Apprehensions about unwanted effects of ADs were widespread, at 51%, 35%, and 43% for coercion, dictatorial reading, and abuse, respectively.
Conclusion: A significant percentage of interviewees were unable to anticipate decisions about treatment options at the end of life. Apprehensions about negative adverse effects of ADs are widespread.
KW  - advance directive
KW  - living will
KW  - decision making
KW  - patient’s desires
KW  - therapy at the end of life
KW  - advanced care planning
Y1  - 2016
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/41729
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-417293
UR  - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993391
UR  - https://www.dovepress.com/intricate-decision-making-ambivalences-and-barriers-when-fulfilling-an-peer-reviewed-article-PPA
SN  - 1177-889X
N1  - This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.
VL  - 10
SP  - 1583
EP  - 1589
PB  - Dove Medical Press
CY  - Albany, Auckland
ER  -