Factors associated with the designation of a health care proxy and writing advance directives for patients suffering from haematological malignancies

Abstract

BackgroundDuring the last few decades, patients’ rights have been reinforced in many countries by acts of law. Measures now include health care proxies to uphold the doctor-patient relationship and advance directives for end-of-life patients. These could be relevant tools as early as the initial diagnosis of haematological malignancies because of the uncertain disease course. The aim of this research was to assess the factors associated with the designation of a proxy and writing advance directives by patients in a haematology department in France.MethodsAfter a specific programme to encourage discussions about end-of-life preferences, we conducted a mixed-methods study comprising retrospective analysis of a random sample of 200 patients’ medical records, crossed with a qualitative analysis of the content of advance directives. Statistical analysis was performed by the RKward V 0.6.1 software with 0.05 denoting significance. The study was performed and presented in accordance with the STROBE guidelines. A thematic analysis of the advance directives was performed by two researchers.ResultsA total of 197 medical records were evaluable. The mean age of the patients was 66 years (range: 18–91). Nearly 2/3 of them (64.5%) designated a proxy, 6.1% wrote advance directives, and 8.1% and 4.6% expressed a wish to meet a religious representative or a volunteer, respectively. The 2-year survival rate was 78.4% [95%CI: 68.2-90.2]. Patients who wrote advance directives were statistically older (p <0.00025). Patients who wrote an advance directive were more likely to have expressed a wish to meet a religious representative (p <0.001) or a volunteer (p = 0.003). Marital status was a significant factor in appointing a proxy (p = 0.04).ConclusionsTo the best of our knowledge, this is the first paper to identify influencing factors for proxies and advance directives in a homogenous population of patients with haematological malignancies. Most patients chose a proxy. However, despite several training programmes for the carers and a care planning programme, few patients wrote advance directives. Our findings suggest that influencing factors are advanced age and a wish to see a religious representative. This study highlights the importance of oral communication about end-of-life issues between carers, patients and their relatives.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-684X-13-57) contains supplementary material, which is available to authorized users.

Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China

“…It appears from our study that religious patients were more likely to endorse ADs. This is similar to previous studies which demonstrated that religion was significantly associated with having an AD [ 25 , 50 ]. Generally, the patients approve religion as an important consideration in their life [ 51 ].…”

“…Our founding indicated that fewer males approved ADs than females. The result was the same as Blackmer et al [ 29 ]; however, this was in contrast to the finding of Trarieux-Signol et al study [ 25 ]. The reasons for this contradiction are not known, although it could be caused by different personality, different population, and different sample size.…”

“…As found in previous studies, life-sustaining treatment not only exhausted patients and caregivers’ body and spirits but also wasted of the country’s precious health resources [15, 25, 40–42]. In their view, the expenditures of aggressive therapy near EOL were pointless.…”

“…The rate of having an AD among subjects is low in most of researches. Previous studies indicate that completion of ADs was 15 to 41 % among the cancer patients [ 11 , 20 , 21 ]; 9 to 70 % among older adults [ 2 , 5 , 16 , 22 ]; 15 to 30 % among general population [ 23 ]; 7 % among hemodialysis patients [ 24 ]; 6 % among hematological malignancy patients [ 25 ]. Dow reported that 63 % of oncology patients did not know what an AD was [ 11 ], and Ewer doubted about the purpose and role of ADs [ 26 ].…”

Advance Care Planning and Decision-Making in a Home-Based Primary Care Service in a Canadian Urban Centre

“…While the majority of charts had documentation of resuscitation status, this is lower than the 97% frequency of code status recorded in a US home-based primary care service, (13) but substantially higher than 6% of those with a hematological malignancy (14) and the 17% to 21% of internal medicine patients aged 80 years or older (15) described in previous research. The impact of this documentation and decision-making are profound, as a study conducted in the US found that “those who had advanced directives used less life sustaining treatment in their last month of life.” (16)…”