Factors Influencing the Completion of Advance Directives in Cancer patients

Aim: This study aimed to investigate the factors influencing the completion of advance directives among cancer patients. Background: Despite the enactment of the Life-Sustaining Treatment Decisions Act in 2018, the rate of advance directive (AD) completion remains low in South Korea. In many cases, end-of-life decisions are made by family members through the Life-Sustaining Treatment Plan rather than by patients themselves, often when death is imminent. To respect patients' preferences and reduce the burden on families, early discussions about withholding or withdrawing life-sustaining treatment should be initiated following a cancer diagnosis. Methods: Data were collected 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 were0.18 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 death preparedness was associated with a 6.78-fold increase in the likelihood of completing an AD. Conclusions : Preparing for death enables cancer patients to live their remaining lives with autonomy, and completing advance directives supports meaningful decision-making.