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Attitudes of patients with malignancies towards completion of advance directives

Supportive Care in Cancer volume 18, pages 367–372 (2010)Cite this article

Abstract

Aim

The purpose of advance directives (AD) is to preserve the patient's autonomy at the end of his/her life. In a cohort study, we investigated attitudes towards AD in hospitalized patients with malignant disease.

Materials and methods

All patients were informed about the basic features of AD in a standardized manner by a single independent physician. One hundred and eight (39 women, 69 men; mean age 56.6 ± 14.9 years) of 140 invited patients completed the study.

Main results

Five percent of patients (5/108) already had an AD; 85% (92/108) did not wish to issue an AD. “Full confidence in physicians” (22%) and “not important for me at the moment” (15%) were the most frequently stated reasons for not issuing an AD. Only 10% (11/108) of patients decided to complete an AD. Their decision was not related to a specific diagnosis or a number of socio-demographic variables that were studied. Patients who decided in favor of an AD had significantly higher Hospital Anxiety and Depression Scale (HADS-D) score than those who decided against it (HADS-D, 8.3 ± 5.0 vs.5.8 ± 4.1, p = 0.035). The patients' HADS depression score was negatively associated with their Karnofsky index (r = −0.232, p = 0.017).

Conclusions

Our data reveal a scarce demand for AD in our population of hospitalized cancer patients. Patients who wanted to issue an AD had a high HADS-D, which is associated with a low performance status.

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Affiliations

  1. Unit of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Katharina A. Kierner, Verena Gartner & Herbert H. Watzke

  2. Institute of Medical Psychology, Centre for Public Health, Medical University of Vienna, Vienna, Austria

    Birgit Hladschik-Kermer

Authors
  1. Katharina A. Kierner
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  2. Birgit Hladschik-Kermer
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  3. Verena Gartner
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  4. Herbert H. Watzke
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Correspondence to Herbert H. Watzke.

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Kierner, K.A., Hladschik-Kermer, B., Gartner, V. et al. Attitudes of patients with malignancies towards completion of advance directives. Support Care Cancer 18, 367–372 (2010). https://doi.org/10.1007/s00520-009-0667-6

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  • DOI: https://doi.org/10.1007/s00520-009-0667-6

Keywords

  • Advance directive
  • Cancer
  • HADS