title: Advance directives in intensive care: Health professional competences.
abstract: OBJECTIVE
  To identify knowledge, skills and attitudes among physicians and nurses of adults' intensive care units (ICUs), referred to advance directives or living wills.
  
  
  METHODS
  A cross-sectional descriptive study was carried out.
  
  
  METHODS
  Nine hospitals in the Community of Madrid (Spain).
  
  
  METHODS
  Physicians and nurses of adults' intensive care.
  
  
  METHODS
  A qualitative Likert-type scale and multiple response survey were made.
  
  
  METHODS
  Knowledge, skills and attitudes about the advance directives. A descriptive statistical analysis based on percentages was made, with application of the chi-squared test for comparisons, accepting p < 0.05 as representing statistical significance.
  
  
  RESULTS
  A total of 331 surveys were collected (51%). It was seen that 90.3% did not know all the measures envisaged by the advance directives. In turn, 50.2% claimed that the living wills are not respected, and 82.8% believed advance directives to be a useful tool for health professionals in the decision making process. A total of 85.3% the physicians stated that they would respect a living will, in cases of emergencies, compared to 66.2% of the nursing staff (p = 0.007). Lastly, only 19.1% of the physicians and 2.3% of the nursing staff knew whether their patients had advance directives (p < 0.001).
  
  
  CONCLUSIONS
  Although health professionals displayed poor knowledge of advance directives, they had a favorable attitude toward their usefulness. However, most did not know whether their patients had a living will, and some professionals even failed to respect such instructions despite knowledge of the existence of advance directives. Improvements in health professional education in this field are needed.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Clínico San Carlos , Madrid, España; Universidad Complutense de Madrid, Madrid, España. Electronic address: tavela01@ucm.es.
authors.forename: T R
authors.initials: TR
authors.lastname: Velasco-Sanz
authors.affiliation: Universidad Complutense de Madrid, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Rayón-Valpuesta
mesh_terms: D016223:Advance Directives; D003422:Critical Care; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011361:Professional Competence; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Advance directives; Cuidados al final de la vida; Cuidados intensivos; End of life care; Instrucciones previas; Intensive care; Living wills; Testamento vital; Voluntades anticipadas