Intricate decision making : ambivalences and barriers when fulfilling an advance directive

  • 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.
Metadaten
Author:Lars Schröder, Gerhard Homme, Stephan Sahm
URN:urn:nbn:de:hebis:30:3-417293
URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993391
URL:https://www.dovepress.com/intricate-decision-making-ambivalences-and-barriers-when-fulfilling-an-peer-reviewed-article-PPA
DOI:https://doi.org/10.2147/PPA.S109040
ISSN:1177-889X
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/27574407
Parent Title (English):Patient preference and adherence
Publisher:Dove Medical Press
Place of publication:Albany, Auckland
Contributor(s):Lucy Goodman, Johnny Chen
Document Type:Article
Language:English
Date of Publication (online):2016/12/12
Date of first Publication:2016/08/16
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2016/12/12
Tag:advance directive; advanced care planning; decision making; living will; patient’s desires; therapy at the end of life
Volume:10
Page Number:7
First Page:1583
Last Page:1589
Note:
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HeBIS-PPN:425327604
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell 3.0