Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre.
BACKGROUND
Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States.


OBJECTIVE
To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues.


METHODS
Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0.


RESULTS
Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive.


CONCLUSIONS
The ACP educational brochure clinically impacts patients' preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.
University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Albert
A
Hing Wong
University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Loh Ee
LE
Chin
University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Tan Li
TL
Ping
Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Ng Kok
NK
Peng
University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Lim Soo
LS
Kun
Advance care planning; Cardiopulmonary resuscitation; End-stage renal disease; Hemodialysis; Palliative care