“I think it’s a bit early for now”: impact of psychological factors on drafting advance directives among cancer patients

Abstract

Various studies have shown that the drafting of Advance Directives (AD) is relatively uncommon. This study was performed to explore cancer patients' attitudes toward advance directives, and their reasons for completing or not completing advance directive forms. The research included interdependent steps designed to gradually collect patients' agreement and comments concerning their participation in an AD study. A thematic content analysis was performed on patients' comments. A total of 147 patients spontaneously agreed to participate before the presentation of the specific theme (AD) of the study. A large majority of the sample reported having no knowledge about ADs. Of the patients who initially agreed to participate, two-thirds declined after the presentation of the theme of the study. The reasons of patients who declined to participate related to avoidance of the issue of death, a focus on present time perspective, or an ambivalence between the AD proposal and recovery plans.This study provides further evidence of the difficulties for patients to express their willingness to engage in AD discussions or research. The extent of the psychological issues experienced by patients and the level of avoidance they expressed raise many questions about the ethical issues and the spread of advance directives used in oncology settings.

Factores que limitan el cumplimiento de voluntades anticipadas en pacientes oncológicos en cuidados paliativos: Revisión sistemática

“…Además, la estandarización del proceso de documentación en registros de salud electrónicos es una propuesta compartida para garantizar la continuidad y accesibilidad de las directivas anticipadas (Aaron SP et al, 2022). La implementación de programas de capacitación para profesionales de la salud se destaca como una medida común entre autores (Wang Y et al, 2021;Cannone P et al, 2019). Asimismo, se aboga por discusiones tempranas y regulares sobre el tratamiento de soporte vital (Kim A et al, 2023;Buiar PG et al, 2019).…”

Early Integrated Palliative Care Within a Surgical Oncology Clinic

“…However, barriers to ACP discussions contribute to suboptimal AD designation in the surgical oncology setting . Patients often lack awareness of these legal documents, avoid discussing death early in the treatment course, and tend to designate ADs during periods of clinical decline . Administrative hurdles to documentation include the lack of standardized systems for reporting and updating ADs .…”

“… 16 Patients often lack awareness of these legal documents, avoid discussing death early in the treatment course, and tend to designate ADs during periods of clinical decline. 17 , 18 , 19 Administrative hurdles to documentation include the lack of standardized systems for reporting and updating ADs. 20 , 21 Surgeons may hesitate to facilitate ACP discussions due to time constraints or concerns that AD designation may limit treatment options they consider appropriate.…”