Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya

Abstract

BackgroundAn advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on life-sustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya.MethodsThe study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study.ResultsIn total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient’s caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient’s functional impairment were the factors with statistically significant association with completion of AD.ConclusionsThe proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient’s functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients.

Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania

“…However, we propose that these objectives are not mutually exclusive. Studies from multiple LMICs have shown that people desire a good quality of death and there is literature precedent for interest in the concept of ACP from LMICs [11,23,62]. Similarly, participants' responses in our study conveyed a positive association between Good Death and EoL Preparation and Life Completion.…”

Socio-cultural contexts of end- of- life conversations and decisions: bereaved family cancer caregivers’ retrospective co-constructions

“…These themes were developed from JNG’s dissertation chapter on death, dying and bereavement transitions in the context of family caregivers’ experiences of ‘midwifing death’ [ 27 ]; watching and waiting on their terminally ill loved ones as death approached. We utilize the term advance directives in the broader sense of and verbal or written instructions conveying ‘a person’s health care preference while they are competent to make decisions for themselves….’ ([ 28 ], p.1) In our specific context advance directives include wills, do-not-resuscitate (DNR) directives, and other variations of end-of-life conversations and decisions regarding terminally ill cancer patients, and from the perspectives of lay family caregivers. The symbol [] indicates omitted sections of text.…”

“…Even so, some of the findings resonate with previously published studies providing a basis for comparative analyses end-of-life matters across varied contexts. For example, a Kenyan based study retrospectively examined advance directives of terminally ill patients based on hospital archived records in a private tertiary hospital [ 28 ]. Findings from this study show that 84.2% of the patients in this study who issued advance directives were cancer patients.…”

Restriction of Fundamental Rights in a Context of Emergency: COVID-19 and the Aspect of Autonomy – Can Autonomy Be Limited?

“…While every patient deserves medical care as Article 43(2) of the Kenyan constitution guarantees every person the right to the highest attainable standard of health 10 , not all of them should receive the same type of care, for some the treatment will be for healing purposes and for others it will be palliative care. That is why, regarding the issue of the patients to whom resources should be assigned, at all times human dignity should prevail as a fundamental value of medical care and ethical behavior.…”