Advance Directives Document: knowledge and experiences of healthcare professionals in Colombia

Abstract

Introduction: The Advanced Directives Document (ADD) is a bioethical quality benchmark for healthcare and assurance of compliance with the rights of autonomy, self-determination and dignity of the patient. This document was established over the past decade and currently there is no evidence about the attitudes and knowledge of the healthcare professionals with regards to the use of this tool in clinical practice in Colombia.
 Objective: To describe the knowledge and experiences of healthcare professionals members of six Colombian Scientific Societies regarding the right to sign an ADD and explore the barriers to its applicability in clinical daily practice.
 Methods: Descriptive, cross-sectional study conducted using an anonymous and voluntary e-survey with the participation of six Colombian Medical Societies. A questionnaire was designed comprising five groups of variables: general, ADD knowledge, medical experiences and personal experiences regarding advanced directives and potential obstacles to its implementation.
 Results: 533 professionals participated in the survey. 54 % (n = 286) expressed their lack of awareness about the fact that there is law governing the ADD in Colombia; 34.33 % (n = 183) said they were familiar with the requirements of the document. Over the last year, 24 % of the professionals received one or more ADDs from their patients. Only 11.7 % of healthcare practitioners had themselves completed an ADD. 77.1 % of the professionals surveyed believe that the number of individuals with an ADD has not changed after the approval and regulation of the right to an advanced directives document. 86.6 % of the practitioners said they respected the ADD, notwithstanding the fact that the patient could benefit otherwise.
 Conclusions: The overall perception of healthcare professionals with regards to the number of ADDs signed by patients is that the number has not changed after the approval of the Law in Colombia. This study evidenced that medical practitioners have a poor knowledge about the ADD and that there is a need to educate healthcare professionals about the ADD and to promptly implement institutional programs about Planning of Advanced Directives (PAD). Both strategies are challenging for the applicability of AD in Colombia.

Content of the advance directives form of the pain and palliative care services in Colombia. Cross-sectional study

“…(17,20) Moreover, only if the ADD meets the legal validity (6,19) The results of this study highlight the opportunities for improvement of the forms, supported by continuing medical education to clarify the conceptual, clinical, ethical and legal aspects of the ADD in the country. (12) In contrast to the clinical variables, little consideration is given to the ethical variables in the forms. Ethical conflicts at the EoL in the physician -family and physician-physician relationships may be avoided if the ADD considers aspects such as quality of life, death with dignity, the right to die with dignity through euthanasia, and patient's values.…”

“…Asks about their quality of life concept and there is a blank space to write the answer (12,14,16) 11…”

“…The variables for content assessment were the rights described in the scientific literature (1,9,(12)(13)(14)(15)(16)18) 1). Each study variable was rated as "compliant: yes/no" to define whether the variable was present (yes) or absent (no).…”

Ethical principles and dilemmas in the discourse of healthcare practitioners involved with end-of-life care based on the Advanced Directives Document

“…The concerns about the validity of the AD are raised to justify the annulment of the ADD. (6) The resolution of these and other conflicts may be achieved via continuous education on medical ethics of the practitioners, a recommendation endorsed by multiple investigations, both at the national (1,31,32) and international level. (2)(3)(4)6,33,34) The specific contribution of this study to the literature on ADD is the identification of the ethical obligations governing healthcare practitioners involved with end-of-life patients, to make decisions vis a vis a particular dilemma, where there is a clear ethical principle such as the respect for prospective autonomy through an ADD, or acting with beneficence in accordance with the particular clinical situation and may be contrary to the statements in the ADD.…”