Abstract
It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.
Similar content being viewed by others
Notes
Law 3/2005, May 23, which regulates the exercise of the right to formulate advance directives in health and creates the appropriate registry. BOCM 140, June 2005.
Law 41/2002, November 14, regulating patient autonomy and rights and obligations of information and clinical documentation. BOE. 274, November 2002.
Law 3/2005, May 23, which regulates the exercise of the right to formulate advance directives in health and creates the appropriate registry. BOCM 140, June 2005.
References
Andorno, R., D.M. Shaw, and B. Elger. 2015. Protecting prisoners’ autonomy with advance directives: Ethical dilemmas and policy issues. Medicine, Health Care and Philosophy 18(1): 33–39.
Antolín, A. 2010. Grade of knowledge about the advance directive document by the chronic patient who comes to the emergency department. Revista Clínica Española 210(8): 379–388.
Arauzo, V., J. Trenado, G. Busqueta, and S. Quintana. 2010. Degree of knowledge on the law of advance directives among the relatives of the patients admitted to ICU. Medicina Cliníca 134(10): 448–451.
Emanuel, E.J., and L.L. Emanuel. 1999. Four models of the physician–patient relationship. In Bioethics for clinicians, edited by A. Couceiro, 109–126. Madrid: Triacastela.
Gracia, D. 2001. Democracy and bioethics. Acta Bioethica 7(2): 343–354.
Gracia, D., and J.J. Rodríguez Sendín. 2006. Information and decision ethics: Patients unable and rendering decisions. In Guidelines on ethics in medical practice: Ethics in palliative care, edited by D. Gracia and J.J. Rodríguez Sendín, 113–132. Madrid: Foundation of Health Sciences.
Herreros, B., M. Pérez, J. Molina, M.D. Martin, and M. Velasco. 2012. Reflections on the advance directive document. Revista Clínica Española 212(8): 422–423.
Jox, R.J., R.J. Horn, and R. Huxtable. 2013. European perspectives on ethics and law in end-of-life care. Handbook of Clinical Neurology 118: 155–165. doi:10.1016/B978-0-444-53501-6.00013-5.
Mateos, A.A., A. Huerta, and M.A. Benito. 2007. Advance directives: Attitude among emergency professionals. Emergencias 19(5): 241–244.
Molina, J., M. Pérez, B. Herreros, M.D. Martín, and M. Velasco. 2011. Knowledge and attitude regarding previous instructions for the patients of a public hospital of Madrid. Revista Clínica Española 211(9): 450–454.
Perceau, E., A. Chirac, W. Rhondali, M. Ruer, C. Chabloz, and M. Filbet. 2014. Audit: Medical record documentation among advanced cancer patients. Bulletin du Cancer 101(2): 120–126.
Pereira, A.D. 2013. Living will and health care proxy: The Portuguese legal situation. Medicine and Law 32(4): 497–502.
Pérez, M., B. Herreros, M.D. Martín, J. Molina, C. Guijarro, and M. Velasco. 2013. Changes in knowledge and carrying out the advance directives of patients admitted to internal medicine. Revista di Calidad Asistencial 28(5): 307–312.
Peterková, H. 2013. Previously expressed wishes in the Czech Republic: A missed chance of the Czech legislator. Medicine and Law 32(4): 429–440.
Sheldon, T. 2013. Dutch doctors to receive more clarity over use of advance euthanasia directives for patients with dementia. BMJ: Clinical Research Edition 346: f3545. doi:10.1136/bmj.f3545.
Simón-Lorda, P., M.I. Tamayo-Velázquez, A. Vázquez-Vicente, A. Durán-Hoyos, J. Pená-González, and P. Jiménez-Zurita. 2008. Knowledge and attitudes of medical staff in two health districts concerning living wills. Atención Primaria 40(2): 61–68.
Solsona, J.F., A. Sucarrats, E. Maull, C. Barbat, S. García, and S. Villares. 2003. Taking decisions at the end of life: A survey of the attitude of critically ill patients against death. Medicina Clínica 120(9): 335–336.
Van Beek, K., K. Woitha, N. Ahmed, et al. 2013. Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (results from the Europall Research Group): A descriptive study. BMC Health Services Research 13: 275. doi:10.1186/1472-6963-13-275.
van der Ham, A.J., Y. Voskes, N. van Kempen, J.E.W. Broerse, and G.A.M. Widdershoven. 2013. The implementation of psychiatric advance directives: Experiences from a Dutch crisis card initiative. Psychiatric Rehabilitation Journal 36(2): 119–121.
Wiese, C.H. 2011. Prehospital emergency physicians’ experiences with advance directives in Germany: A questionnaire-based multicenter study. Minerva Anestesiologica 77(2): 172–179.
Acknowledgements
The research team would like to thank Venktesh Ramnath for his work revising and editing this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pérez, M., Herreros, B., Martín, M.D. et al. Do Spanish Hospital Professionals Educate Their Patients About Advance Directives?. Bioethical Inquiry 13, 295–303 (2016). https://doi.org/10.1007/s11673-016-9703-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11673-016-9703-7