Factors influencing the completion of advance directives in cancer patients: a descriptive survey
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Aim
This study aimed to investigate the factors associated with the completion of advance directives among cancer patients.
Background
Despite legislation to support end-of-life decision-making, the completion rate of advance directives (AD) in South Korea remains low. In many cases, family members make end-of-life decisions on behalf of patients. To promote patient autonomy and reduce family burden, early initiation of AD discussions is essential.
Methods
Survey data on demographics and factors related to AD completion were collected through a written survey administered by the researchers from 148 cancer patients at a tertiary hospital between November 2, 2023, and March 10, 2024. Data analysis included frequency, percentage, mean, standard deviation, χ²-test, independent t-test, Pearson’s correlation coefficient, and multivariate logistic regression.
Results
Compared to patients aged 70 and older, those under 60 were 0.18 times as likely, and those aged 60 to 69 were 0.27 times as likely, to complete an AD. Patients with a middle school education or less were 12.46 times more likely to complete an AD than those with higher education levels. Having prior experience discussing the withdrawal of life-sustaining treatment during the death of a loved one increased the likelihood of completing an AD by 18.64 times. Additionally, each 1-point increase in psychological and formal Readiness for Death was associated with a 6.78-fold increase in the likelihood of completing an AD. Age, education level, prior experience, and particularly Readiness for Death were found to be associated with AD completion among cancer patients.
Conclusions
AD completion among cancer patients was associated with age, education level, prior discussion of LST withdrawal, and Readiness for Death. These findings highlight factors that may inform future interventions to support patient autonomy via increased uptake of ADs.
