title: Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients.
abstract: The goals of this study were: (1) to evaluate patients' knowledge regarding advance directives and completion rates of advance directives among gynecologic oncology patients and (2) to examine the association between death anxiety, disease symptom burden, and patient initiation of advance directives.
  
  
  
  110 gynecologic cancer patients were surveyed regarding their knowledge and completion of advance directives. Patients also completed the MD Anderson Symptom Inventory (MDASI) scale and Templer's Death Anxiety Scale (DAS). Descriptive statistics were utilized to examine characteristics of the sample. Fisher's exact tests and 2-sample t-tests were utilized to examine associations between key variables.
  
  
  
  Most patients were white (76.4%) and had ovarian (46.4%) or uterine cancer (34.6%). Nearly half (47.0%) had recurrent disease. The majority of patients had heard about advance directives (75%). Only 49% had completed a living will or medical power of attorney. Older patients and those with a higher level of education were more likely to have completed an advance directive (p<0.01). Higher MDASI Interference Score (higher symptom burden) was associated with patients being less likely to have a living will or medical power of attorney (p=0.003). Higher DAS score (increased death anxiety) was associated with patients being less likely to have completed a living will or medical power of attorney (p=0.03).
  
  
  
  Most patients were familiar with advance directives, but less than half had created these documents. Young age, lower level of education, disease-related interference with daily activities, and a higher level of death anxiety were associated with decreased rates of advance directive completion, indicating these may be barriers to advance care planning documentation. Young patients, less educated patients, patients with increased disease symptom burden, and patients with increased death anxiety should be targeted for advance care planning discussions as they may be less likely to engage in advance care planning.
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: AJBrown@mdanderson.org.
authors.forename: Alaina J
authors.initials: AJ
authors.lastname: Brown
authors.affiliation: Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Megan Johnson
authors.initials: MJ
authors.lastname: Shen
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Urbauer
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jolyn
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Department of Behavioral Science, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Parker
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Carmack
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Prescott
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kolawole
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Rosemore
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sun
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Ramondetta
authors.affiliation: Department of Clinical Education, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Bodurka
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards*; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D001293:Attitude to Death; D004282:Documentation / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000523:psychology* / Q000628:therapy; D011594:Psychometrics / Q000379:methods; D014594:Uterine Neoplasms / Q000523:psychology* / Q000628:therapy; D055815:Young Adult
keywords: Advance care planning; End-of-life