title: Advance directives in the context of end-of-life palliative care.
abstract: OBJECTIVE
  To review the definition of advanced directive, understand the implications for the patient, family and healthcare team, and address the obstacles involved in the implementation.
  
  
  RESULTS
  Advanced directives propose a model of healthcare based on patient preferences. Although there is sufficient evidence related to their usefulness, various factors are known to affect the use of advanced directives. Therefore, rules need to be established in order to optimize the implementation process.
  
  
  CONCLUSIONS
  An advanced directive is a legal document based on the principle of autonomy that expresses the desire of the patient in relation to different medical treatments when the patient is unable to make those decisions. The advanced directives are represented in three formats: Living Will, Appointment of a Healthcare Proxy and Legal Status of Preferences. The uses of advanced directives have an impact not only on the patients and their families, but also on the healthcare team. Despite their utility being well known, there are several general barriers that affect implementation, as well as factors related to characteristics of each study population.
authors.affiliation: aPalliative Care Team, Department of Clinical, C Bonorino Udaondo Gastroenterology Hospital bPallium Latinoamerica, Bonpland, Buenos Aires, Argentina.
authors.forename: Marisa del V
authors.initials: Mdel V
authors.lastname: Pérez
authors.forename: Marina J
authors.initials: MJ
authors.lastname: Macchi
authors.forename: Alejo F
authors.initials: AF
authors.lastname: Agranatti
mesh_terms: D024362:Advance Directive Adherence; D016223:Advance Directives / Q000191:economics / Q000331:legislation & jurisprudence* / Q000523:psychology; D006801:Humans; D010166:Palliative Care / Q000191:economics / Q000523:psychology / Q000592:standards*; D057240:Patient Preference; D019452:Terminally Ill / Q000523:psychology*; D014481:United States