Characteristics and use of advance directives in a tertiary hospital. Period 2001-2011.
OBJECTIVE
To evaluate the characeristics of patients who provide written advance directives and their use in healthcare practice.


METHODS
Observational, descriptive, retrospective study of all written advance directives registered at a university hospital between 2001-2011. The clinical-demographic characteristics of the patients at the time they provided the documents was studied, as was as the later use of the documents through an electronic medical history analysis.


RESULTS
A total of 130 advance directive documents were registered. At the time of their provision, the average patient age was 61 years; some 64% were diagnosed with a neoplastic illness; 73% were completely independent (Barthel), and 36.4% presented no comorbidities (Charlson). The women were slightly older than the men (63 vs. 60, P=0.17), and they were more likely to provide advance directives (61.5% vs. 31.5%, P=0.01) than men; the womens' illnesses were less relevant (P=0.001), and the women presented less comorbidity (P=0.01). A total of 361 medical acts were reviewed (193 hospital admissions and 168 emergency visits). At the end of the study, 74 patients were alive (57%), 37 had died (28%), and in 19 cases (15%), their evolution was lost. Of those who died, 13 (35.1%) were functionally incapacitated in the terminal phase of their illness, and in 9 (69%), the advance directives were applied in the final phase of their illness.


CONCLUSIONS
The number of registered advance directives is low; they do not interfere in the care process, and the documents are considered in the final decisions of life.
Área Urgencias, Hospital Clínic, Grupo Investigación «Urgencias: procesos y patologías», Fundació Clínic, Barcelona, España. Electronic address: antolin@clinic.ub.es.
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Antolín
Área Urgencias, Hospital Clínic, Grupo Investigación «Urgencias: procesos y patologías», Fundació Clínic, Barcelona, España.
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Jiménez
Área Urgencias, Hospital Clínic, Grupo Investigación «Urgencias: procesos y patologías», Fundació Clínic, Barcelona, España; Servicio de Atención al Usuario, Hospital Clínic, Barcelona, España.
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González
Área Urgencias, Hospital Clínic, Grupo Investigación «Urgencias: procesos y patologías», Fundació Clínic, Barcelona, España.
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Gómez
Área Urgencias, Hospital Clínic, Grupo Investigación «Urgencias: procesos y patologías», Fundació Clínic, Barcelona, España.
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Sánchez
Área Urgencias, Hospital Clínic, Grupo Investigación «Urgencias: procesos y patologías», Fundació Clínic, Barcelona, España.
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Miró
Advance directives; Bioethics; Bioética; End of life; Final de la vida; Instrucciones previas; Prior instructions; Voluntades anticipadas