title: The impact of a tumor diagnosis on patients' attitudes toward advance directives.
abstract: BACKGROUND
  Although advance care planning and the completion of advance directives (ADs) are important tools to avoid unwanted aggressive care once patients have lost their decision-making capacity, only a minority of cancer patients are admitted with completed ADs, and little is known about patients' wishes regarding AD consultations.
  
  
  METHODS
  For 1 year, every new patient admitted to the hematology/oncology outpatient clinic of the University Hospital Regensburg received a self-administered questionnaire comprising a self-evaluation of AD knowledge and questions about preferences regarding consultation partners and the time of consultation. Disease-related data were collected from medical records. Statistics were calculated with SPSS.
  
  
  RESULTS
  Of the 500 questionnaires handed out, 394 (75%) were evaluable and analyzed. Twenty-eight percent of the participants had completed an AD (living will or health care proxy). Ninety-two percent of the participants without ADs had never received a consultation offer from any professional involved. Only 20% perceived a clear relation between cancer and AD consultations. More than 50% of the participants without ADs were in favor of consultations 'now' or 'in a few weeks', while more than 40% objected to AD consultations.
  
  
  CONCLUSIONS
  Oncology patients have a large unmet demand for AD consultations. However, a relevant percentage of these patients object to AD consultations. Structured and early AD consultation offers should be made, and early discussions about indications for aggressive treatment should take place.
authors.affiliation: Department of Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Pfirstinger
authors.forename: Daniel
authors.initials: D
authors.lastname: Kattner
authors.forename: Matthias
authors.initials: M
authors.lastname: Edinger
authors.forename: Reinhard
authors.initials: R
authors.lastname: Andreesen
authors.forename: Martin
authors.initials: M
authors.lastname: Vogelhuber
mesh_terms: D000293:Adolescent; D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult