[Knowledge, attitude and opinion of patients regarding the new German legislation on advance care planning : Results of a survey in a department of general internal medicine].
BACKGROUND
In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear.


OBJECTIVE
Analysis of knowledge, attitude and opinion of patients in a general internal medical department regarding advance care planning in general and the recent German legislation.


METHODS
A total of 200 consecutive patients in an internal medicine ward were interviewed with the help of a questionnaire regarding their attitude to and knowledge on advance care planning in general and the current legislation.


RESULTS
Approximately 40 % of the patients had issued some form of directive (either advance care directive or health care proxy) and only 7.5 % were advised by their physicians to make an advance directive. Patients with no directive were not willing to deal with dying and death, were not well-informed about directives or assumed that relatives or physicians would make an appropriate decision. Characteristics of the new legislation were controversially assessed; only 21 % of the patients wished to have a literal implementation of their directive. Regarding the content of an advance directive, more than 80 % of the patients voted for pain control in the palliative setting.


CONCLUSIONS
The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.
Medizinische Klinik, Bethlehem-Gesundheitszentrum Stolberg, Steinfeldstraße 5, 52078, Stolberg, Deutschland.
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Elmeadawy
Institut für medizinische Statistik, UK Aachen, Aachen, Deutschland.
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Fitzner
Klinik für Palliativmedizin, UK Aachen, Aachen, Deutschland.
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Elsner
Medizinische Klinik, Bethlehem-Gesundheitszentrum Stolberg, Steinfeldstraße 5, 52078, Stolberg, Deutschland. dietrich@bethlehem.de.
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Dietrich
D016223:Advance Directives / Q000331:legislation & jurisprudence*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006748:Hospital Departments / Q000331:legislation & jurisprudence*; D006801:Humans; D007388:Internal Medicine / Q000331:legislation & jurisprudence*; D007872:Legal Guardians / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D010166:Palliative Care / Q000331:legislation & jurisprudence
Advance care planning; Healthcare proxy; Legislation; Obligation; Unlimited validity