title: Motivations, aims and communication around advance directives: a mixed-methods study into the perspective of their owners and the influence of a current illness.
abstract: OBJECTIVE
  What are motivations of owners of an advance directive (AD) to draft an AD, what do they aim for with their AD and do they communicate about their AD?
  
  
  METHODS
  Written questionnaires were sent to a cohort of people owning different types of ADs (n=5768). A purposive sample of people suffering from an illness was selected from the cohort for an in-depth interview (n=29).
  
  
  RESULTS
  About half of our population had no direct motivation to draft their AD. Most mentioned motivation for the other half was an illness of a family member or friend. Many different and specific aims for drafting an AD were mentioned. An often mentioned more general aim in people with different ADs was to prevent unnecessary lengthening of life or treatment (14-16%). Most respondents communicated about having an AD with close-ones (63-88%) and with their GP (65-79%). In the interviews people gave vivid examples of experiences of what they hoped to prevent at the end of life. Some mentioned difficulties foreseeing the future and gave examples of response shift.
  
  
  CONCLUSIONS
  ADs can give directions to caregivers about what people want at the end of life.
  
  
  CONCLUSIONS
  ADs have to be discussed in detail by their owners and caregivers, since owners often have specific aims with their AD.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands. Electronic address: eol@vumc.nl.
authors.forename: Matthijs P S
authors.initials: MP
authors.lastname: van Wijmen
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.affiliation: Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
authors.forename: Guy A M
authors.initials: GA
authors.lastname: Widdershoven
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Advance care planning; Advance directives; Communication; Decision making; End of life