Adopting Advance Directives Reinforces Patient Participation in End-of-Life Care Discussion.
OBJECTIVE
In Korea, most terminal cancer patients have still not been included in end-of-life (EOL) discussions. The purpose of this study was to evaluate the proportion of patients participating in EOL discussions after adopting advance directives.


METHODS
Medical records of 106 hospice patients between July 2012 and February 2013 were reviewed retrospectively. The proportion of patient participation in EOL discussions, barriers, and favorable factors for completion of advance directives, as well as outcomes of advance directives were evaluated.


RESULTS
Patient participation in EOL discussion had increased from 16/53 (30%) to 27/53 (51%) since adopting advance directives (p < 0.001). Median time between completion of an advance directive and death increased from 8 days (range, 0 to 22 days) to 14.5 days (range, 0 to 47 days). Patients' poor condition after late referral was the main barrier to missing EOL discussions; however, family members' concerns about patient's distress was also a main reason for excluding the patient from EOL discussions. In univariate analysis, patient age, education status, and time from diagnosis to completion of an advance directive influenced advance directive completion favorably. Following multivariate analysis, higher education and periods of more than 2 years from diagnosis to completion of an advance directive remained favorable (odds ratio [OR], 9.586, p=0.024 and OR, 70.312; p=0.002). Preferences of all patients regarding cardiopulmonary resuscitation or hemodialysis were carried out by physicians. Orders for nutrition and palliative sedation showed discordance, with concordance rates of 74.2% and 51.6%, respectively.


CONCLUSIONS
Our results suggested that the use of advance directive promote patient participation in EOL discussion.
Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.|St. Vincent's Hospital Hospice Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Ji Hyung
JH
Hong
Division of Hemato-oncology, Department of Internal Medicine, Hallym Universit Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Jung Hye
JH
Kwon
St. Vincent's Hospital Hospice Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.|Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Il Kyu
IK
Kim
St. Vincent's Hospital Hospice Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Jin Hee
JH
Ko
St. Vincent's Hospital Hospice Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Yi-Jin
YJ
Kang
St. Vincent's Hospital Hospice Center, College of Medicine, The Catholic University of Korea, Suwon, Korea.|Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Hoon-Kyo
HK
Kim
D000293:Adolescent; D000328:Adult; D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D056910:Republic of Korea; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
Advance directives; Decision making; Personal autonomy