Abstract
Objectives: 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.
Methods: Cancer patients, healthy controls, nursing staff, and physicians (n = 100 in each group) were surveyed by means of a structured questionnaire.
Results: 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.
Conclusions: Only a minority of the participants had written an advance directive and knew about the possibility of authorising 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.
Full Text
The Full Text of this article is available as a PDF (65.4 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Dyer Clare. Bill clarifies gap in law over living wills. BMJ. 2004 Jun 26;328(7455):1516–1516. doi: 10.1136/bmj.328.7455.1516-d. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Emanuel L. L., Barry M. J., Stoeckle J. D., Ettelson L. M., Emanuel E. J. Advance directives for medical care--a case for greater use. N Engl J Med. 1991 Mar 28;324(13):889–895. doi: 10.1056/NEJM199103283241305. [DOI] [PubMed] [Google Scholar]
- Fagerlin Angela, Schneider Carl E. Enough. The failure of the living will. Hastings Cent Rep. 2004 Mar-Apr;34(2):30–42. [PubMed] [Google Scholar]
- Hofmann J. C., Wenger N. S., Davis R. B., Teno J., Connors A. F., Jr, Desbiens N., Lynn J., Phillips R. S. Patient preferences for communication with physicians about end-of-life decisions. SUPPORT Investigators. Study to Understand Prognoses and Preference for Outcomes and Risks of Treatment. Ann Intern Med. 1997 Jul 1;127(1):1–12. doi: 10.7326/0003-4819-127-1-199707010-00001. [DOI] [PubMed] [Google Scholar]
- Johnson R. F., Jr, Baranowski-Birkmeier T., O'Donnell J. B. Advance directives in the medical intensive care unit of a community teaching hospital. Chest. 1995 Mar;107(3):752–756. doi: 10.1378/chest.107.3.752. [DOI] [PubMed] [Google Scholar]
- Orentlicher D. From the Office of the General Counsel. Advance medical directives. JAMA. 1990 May 2;263(17):2365–2367. doi: 10.1001/jama.263.17.2365. [DOI] [PubMed] [Google Scholar]
- Palker N. B., Nettles-Carson B. The prevalence of advance directives: lessons from a nursing home. Nurse Pract. 1995 Feb;20(2):7-8, 13, 17-8, passim. [PubMed] [Google Scholar]
- Reilly B. M., Wagner M., Magnussen C. R., Ross J., Papa L., Ash J. Promoting inpatient directives about life-sustaining treatments in a community hospital. Results of a 3-year time-series intervention trial. Arch Intern Med. 1995 Nov 27;155(21):2317–2323. [PubMed] [Google Scholar]
- Robertson J. A. Second thoughts on living wills. Hastings Cent Rep. 1991 Nov-Dec;21(6):6–9. [PubMed] [Google Scholar]
- Sahm S. W. Palliative care versus euthanasia. The German position: the German General Medical Council's principles for medical care of the terminally ill. J Med Philos. 2000 Apr;25(2):195–219. doi: 10.1076/0360-5310(200004)25:2;1-O;FT195. [DOI] [PubMed] [Google Scholar]
- Schröder Christina, Schmutzer Gabriele, Brähler Elmar. Repräsentativbefragung der deutschen Bevölkerung zu Aufklärungswunsch und Patientenverfügung bei unheilbarer Krankheit. Psychother Psychosom Med Psychol. 2002 May;52(5):236–243. doi: 10.1055/s-2002-28526. [DOI] [PubMed] [Google Scholar]
- Teno J., Lynn J., Wenger N., Phillips R. S., Murphy D. P., Connors A. F., Jr, Desbiens N., Fulkerson W., Bellamy P., Knaus W. A. Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 1997 Apr;45(4):500–507. doi: 10.1111/j.1532-5415.1997.tb05178.x. [DOI] [PubMed] [Google Scholar]
- Tonelli M. R. Pulling the plug on living wills. A critical analysis of advance directives. Chest. 1996 Sep;110(3):816–822. doi: 10.1378/chest.110.3.816. [DOI] [PubMed] [Google Scholar]