title: Attitudes of patients with malignancies towards completion of advance directives.
abstract: OBJECTIVE
  The purpose of advance directives (AD) is to preserve the patient's autonomy at the end of his/her life. In a cohort study, we investigated attitudes towards AD in hospitalized patients with malignant disease.
  
  
  METHODS
  All patients were informed about the basic features of AD in a standardized manner by a single independent physician. One hundred and eight (39 women, 69 men; mean age 56.6 +/- 14.9 years) of 140 invited patients completed the study.
  
  
  RESULTS
  Five percent of patients (5/108) already had an AD; 85% (92/108) did not wish to issue an AD. "Full confidence in physicians" (22%) and "not important for me at the moment" (15%) were the most frequently stated reasons for not issuing an AD. Only 10% (11/108) of patients decided to complete an AD. Their decision was not related to a specific diagnosis or a number of socio-demographic variables that were studied. Patients who decided in favor of an AD had significantly higher Hospital Anxiety and Depression Scale (HADS-D) score than those who decided against it (HADS-D, 8.3 +/- 5.0 vs.5.8 +/- 4.1, p = 0.035). The patients' HADS depression score was negatively associated with their Karnofsky index (r = -0.232, p = 0.017).
  
  
  CONCLUSIONS
  Our data reveal a scarce demand for AD in our population of hospitalized cancer patients. Patients who wanted to issue an AD had a high HADS-D, which is associated with a low performance status.
authors.affiliation: Unit of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. katharina.kierner@meduniwien.ac.at
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Kierner
authors.forename: Birgit
authors.initials: B
authors.lastname: Hladschik-Kermer
authors.forename: Verena
authors.initials: V
authors.lastname: Gartner
authors.forename: Herbert H
authors.initials: HH
authors.lastname: Watzke
mesh_terms: D000328:Adult; D024362:Advance Directive Adherence / Q000706:statistics & numerical data*; D016223:Advance Directives / Q000523:psychology* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D015331:Cohort Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D011159:Population Surveillance; D055815:Young Adult