The cancer specific advance directive.
BACKGROUND
Advance directives are an important part of end of life care, but current advance directive documents do not address the specific issues facing cancer patients. The authors' purpose was: 1) to develop a cancer specific advance directive, 2) determine whether oncology outpatients find this directive more acceptable than a generic advance directive, and 3) describe oncology outpatient preferences for life-sustaining treatment.


METHODS
A cancer specific advance directive ("The Cancer Living Will"; the full text of the updated version is available at the University of Toronto Joint Centre for Bioethics website [URL: www.utoronto.ca/jcb]) was developed in four steps: 1) literature search, 2) key informant interviews, 3) focus groups, and 4) evaluation of face and content validity. Subsequently, 91 volunteer oncology patients were given copies of the cancer specific advance directive and the generic advance directive ("The University of Toronto Centre for Bioethics Living Will") from which it was adapted. Acceptability of the advance directive was measured by determining the participants' preferred directive. Participants recorded their treatment preferences in both the cancer specific and generic advance directives.


RESULTS
Of 60 patients who returned their questionnaires, 50 expressed a preference for the advance directive. Thirty-two patients (64%; 95% confidence interval (CI), 49-77%) preferred the disease specific Cancer Living Will and 18 patients (36%; 95% CI, 23-51%) preferred the generic Centre for Bioethics Living Will. Most participants who preferred the Cancer Living Will did so because it was more specific and relevant to their situation.


CONCLUSIONS
The authors have developed and evaluated a cancer specific advance directive that they believe can be recommended for clinical use with cancer patients.
Berry
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SR
University of Toronto Joint Centre for Bioethics, and Department of Medical Oncology, Toronto-Sunnybrook Regional Cancer Centre, Ontario, Canada.
Singer
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PA
D000368:Aged; D001675:Bioethics; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016224:Living Wills; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology