Completion Rates of Advance Directives in a Trauma Emergency Room: Association with Age

Abstract

Introduction An advance directive (AD) is a written legal document in which a person can express wishes and preferences for medical treatment for the moment when that person is no longer able to make medical decisions because of a serious illness or injury. While ADs have emerged in public, it is unclear, how many adults in Germany have completed an AD, and frequencies differ among different patient cohorts and medical settings. The aim of this study was to evaluate how many patients visiting a trauma emergency room (ER) in an academic teaching hospital had completed an AD. Furthermore, patient characteristics were compared between patients who had completed an AD and those who had not completed an AD. Methods. Patients with a traumatic injury or disease who attended the ER of an academic teaching hospital in the period from October 2015 to March 2016 (n = 499) were surveyed for completion rates of ADs. Results. Prior to their visit to the ER, 12.8% of the included patients possessed a completed AD. Patients with a completed AD had a higher age (median age: 54 (IQR: 34–66) vs. 35 (IQR: 25–50) p < 0.001 ) and were less often living in an urban residential location (UR) (UR: 23.5% vs. 39.4%, p = 0.029 ). Groups did not differ between sex ( p = 0.115 ), frequencies of high school graduates ( p = 0.482 ), and possession of a private health insurance ( p = 0.072 ), disability insurance ( p = 0.291 ), or an accident insurance ( p = 0.790 ). Conclusion. Completion rates of ADs remain low among patients visiting an ER of an academic teaching hospital in Germany. Increasing age but not factors such as sex, educational background, or insurance status were associated with a higher frequency of completed ADs.

Are we waiting for the sky to fall? Predictors of withdrawal of life-sustaining support in older trauma patients: A retrospective analysis

“…4 Other studies examining advance directives among trauma patients demonstrated an approximate rate of preinjury ADLC of 12%, which is greater than that noted in this study. 13,14 This study's demographics are consistent with those seen in other investigations of ADLC, with more advance directives held by female patients, individuals from White non-Hispanic race and ethnicity groups, and patients with preexisting comorbidities. 13,15,16 Despite the small number of patients who presented with ADLC, our study showed one intended benefit of advance care planning as patients with ADLC underwent WLSS approximately 24 hours earlier compared with those who did not have advance directives.…”

“…Our results reveal that only a small percentage of older trauma patients have advance directives on file at the time of admission, which is significantly less than previous systematic reviews of advance directive completion 4 . Other studies examining advance directives among trauma patients demonstrated an approximate rate of preinjury ADLC of 12%, which is greater than that noted in this study 13,14 . This study's demographics are consistent with those seen in other investigations of ADLC, with more advance directives held by female patients, individuals from White non-Hispanic race and ethnicity groups, and patients with preexisting comorbidities 13,15,16 …”

End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany

“…In the current study, we demonstrated that the number of precautionary powers of attorney increased in parallel with the increasing prevalence of advance directives. Although completion rates of advance directives differ among patient subgroups and medical disciplines, recent data indicate an increasing number of patients to complete an advance directive in Germany [9,15,20,21]. Because all studies are descriptive in nature, it is unclear whether and to what extent factors like a new law or increased awareness in the media have contributed to this trend.…”

Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience

“…Although increasing over the recent decade, completion rates of advance directives remain low in Germany [ 6 ]. Seniors seem to complete an advance directive more frequently compared to people in the working age [ 8 ]. However, there is also evidence that older people and patients with progressive comorbidities have thought about end-of life issues within their families and selected substitute decision makers, but most of them did not complete written documents or discuss their preferences with a physician [ 18 ].…”

“…Promotion for completion of advance directives by legal reforms and informal support might have led to an increase of advance directive completion rates over the last decade [ 4 , 5 , 6 ]. However, completion rates of advance directives remain low in general [ 7 , 8 ].…”