ATTITUDES AND DIFFERENCES BETWEEN PATIENTS WITH CANCER AND NON-CANCER PATIENTS ON ADVANCE DIRECTIVES

• Published in: Anticancer research 2018-09, Vol.38 (9), p.5553
• Main Authors: Lekkala, Manidhar, Talluri, Swapna, Abdullah, Amirahwathy, Pachpande, Vrushali, Zachary, Wolfe, Ghimire, Subash, Pamula, John
• Format: Article
• Language: English
• Subjects: Attitudes; Cancer; Dementia disorders; Encephalopathy; Etiology; Health care; Medical personnel; Patients; Physicians; Social services
• ISSN: 0250-7005; 1791-7530

Background: Advance directives (AD) enable healthcare professionals to ascertain patient preferences for care both legally and ethically (1). These directives need to be made jointly by well-informed, competent patients and physicians. Studies have shown that advanced care planning increases the utilization of hospice and palliative care, and results in better compliance with patients’ end-of-life wishes [reviewed in (2)]. Even then, the rate of completion of AD is very low and physician involvement is minimal. Aim: To explore the attitudes of the hospitalized patients regarding AD and to understand the factors affecting completion of AD. Materials and Methods: Thirty patients with cancer and 30 patients without cancer, admitted to the hospital for medical reasons were randomly selected. A questionnaire was administered to ascertain their attitude towards and completion of AD. Patients with dementia, encephalopathy of any etiology, or if determined to be medically incompetent, were excluded from the study. Results: A total of 18/30 patients with cancer and only 10/30 without cancer had AD. Only a small percentage of cancer patients (16%) recalled that a physician–patient discussion was held on AD. The majority of patients completed AD on their own initiative with their family and friends. While 93% of patients with cancer had knowledge regarding AD, only 66% in those without cancer had similar knowledge. In both groups, 50% of patients who did not have AD expressed interest in finishing them during their hospital stay. A discussion was made with these patients regarding the importance of AD and social services was involved to facilitate the process. Conclusion: Patients with cancer are more likely to have knowledge about AD, despite minimal physician involvement. Moreover, they are more likely to complete AD. A commonly misunderstood perception among physicians is that discussing AD is a taboo topic. Considering that a large proportion of patients are interested in making AD, more resources if allocated could result in good outcomes. As phase two of this project, we are working on a multi-disciplinary approach to improve patient outcomes.