Attitudes toward end-of-life care and advance directives: a prospective survey in a family medicine clinic, Bangkok, Thailand

Authors

  • Basmon Manomaipiboon Faculty of Medicine, Vajira Hospital, Navamindhradhiraj University, Bangkok, Thailand
  • Suttipat Wongvitvichot Faculty of Medicine, Vajira Hospital, Navamindhradhiraj University, Bangkok, Thailand
  • Chavanant Sumanasrethakul Faculty of Medicine, Vajira Hospital, Navamindhradhiraj University, Bangkok, Thailand
  • Benjarat Sutjakul Faculty of Science and Health Technology, Navamindhradhiraj University, Bangkok, Thailand
  • Olan Anantanupong Faculty of Medicine, Vajira Hospital, Navamindhradhiraj University, Bangkok, Thailand
  • Siam Sae-tang Faculty of Medicine, Vajira Hospital, Navamindhradhiraj University, Bangkok, Thailand
  • Suchitra Sutthimethakorn Faculty of Medicine, Vajira Hospital, Navamindhradhiraj University, Bangkok, Thailand

Keywords:

Advance care planning, advance directive, attitudes, end-of-life care

Abstract

Background: Advance directives (ADs) have long been legalized and advocated, still few patients complete ADs in Thailand. In our setting, advance directive information will be provided to interested patients and palliative care patients.

Objectives: This study examined the attitude toward end-of-life care and ADs, the prevalence of ADs completion and identified the factors associated with advance care planning among patients who attended a family medicine clinic, Faculty of Medicine, Vajira Hospital, Navamindhradhiraj university, Bangkok, Thailand.

Methods: A total of 300 subjects completed a self-administered structured questionnaire, including sociodemographic factors, individuals’ health status, healthcare experiences, and other factors influencing advance care planning.

Results: The overall mean age was 52.0 ± 17.7 years; 71.0% were female. Only 20.0% received information regarding ADs, and 3.0% completed ADs. Surprisingly, more than 70.0% were interested in receiving more information regarding ADs. Adjusting for other variables, acceptance of ADs was significantly associated with the female gender, education level, both secondary school completion and a university degree or higher, and experience in caring for chronically ill relatives.

Conclusion: Our findings showed that an extremely low percentage of subjects completed ADs, as most had never heard of them. They were eager to obtain more information and considered it essential knowledge. This knowledge gap could guide policy planners to formulate strategies and implement advance care planning.

Downloads

Download data is not yet available.

References

Cohen-Mansfield J, Skornick-Bouchbinder M, Brill S.Trajectories of end of life: A systematic review. JGerontol B Psychol Sci Soc Sci 2018;73:564-72. https://doi.org/10.1093/geronb/gbx093 PMid:28977651

Krikorian A, Maldonado C, Pastrana T. Patient'sperspectives on the notion of a good death: Asystematic review of the literature. J Pain SymptomManage 2020;59:152-64. https://doi.org/10.1016/j.jpainsymman.2019.07.033 PMid:31404643

Solberg CT, Gamlund E. The badness of death andpriorities in health. BMC Med Ethics 2016;17:21. https://doi.org/10.1186/s12910-016-0104-6 PMid:27076188 PMCid:PMC4831083

Sepulveda JMG, Baid D, Johnson FR, Finkelstein EA.What is a good death? A choice experiment on careindicators for patients at end of life. J Pain SymptomManage 2022;63:457-67. https://doi.org/10.1016/j.jpainsymman.2021.11.005 PMid:34793947 PMCid:PMC9341237

Schichtel M, Wee B, Perera R, Onakpoya I. The effectof advance care planning on heart failure: A systematicreview and meta-analysis. J Gen Intern Med 2020;35:874-84. https://doi.org/10.1007/s11606-019-05482-w PMid:31720968 PMCid:PMC7080664

Agarwal R, Epstein AS. Advance care planning andend-of-life decision making for patients with cancer.Semin Oncol Nurs 2018;34:316-26. https://doi.org/10.1016/j.soncn.2018.06.012 PMid:30100366 PMCid:PMC6156999

Lum HD, Sudore RL, Bekelman DB. Advance careplanning in the elderly. Med Clin North Am 2015;99:391-403. https://doi.org/10.1016/j.mcna.2014.11.010 PMid:25700590

MacKenzie MA, Smith-Howell E, Bomba PA,Meghani SH. Respecting choices and related modelsof advance care planning: A systematic review ofpublished evidence. Am J Hosp Palliat Care2018;35:897-907. https://doi.org/10.1177/1049909117745789 PMid:29254357 PMCid:PMC6580846

Detering KM, Hancock AD, Reade MC, Silvester W.The impact of advance care planning on end of lifecare in elderly patients: randomised controlled trial.BMJ 2010;340:c1345. https://doi.org/10.1136/bmj.c1345 PMid:20332506 PMCid:PMC2844949

Song MK, Kirchhoff KT, Douglas J, Ward S, HammesB. A randomized, controlled trial to improve advancecare planning among patients undergoing cardiacsurgery. Med Care 2005;43:1049-53. https://doi.org/10.1097/01.mlr.0000178192.10283.b4 PMid:16166875

Morris SE, Sannes TS. Bereavement care for familycaregivers of neuro-oncology patients. Ann PalliatMed 2021;10:953-63. https://doi.org/10.21037/apm-20-708 PMid:32648450

Rodríguez-Prat A, Monforte-Royo C, Porta-Sales J,Escribano X, Balaguer A. Patient perspectives ofdignity, autonomy and control at the end of life:Systematic review and meta-ethnography. PLoS One2016;11:e0151435. https://doi.org/10.1371/journal.pone.0151435 PMid:27010323 PMCid:PMC4806874

Castillo LS, Williams BA, Hooper SM, Sabatino CP,Weithorn LA, Sudore RL. Lost in translation: Theunintended consequences of advance directive lawon clinical care. Ann Intern Med 2011;154:121-8. https://doi.org/10.7326/0003-4819-154-2-201101180-00012 PMid:21242368 PMCid:PMC3124843

Hooper S, Sabatino CP, Sudore RL. Improving medical-legal advance care planning. J Pain Symptom Manage2020;60:487-94. https://doi.org/10.1016/j.jpainsymman.2020.03.004 PMid:32240757 PMCid:PMC7830774

Manomaipiboon B, Assawawitoontip S, KokaewichainS, Manasvanich B. An educational video interventionto increase advance care planning in a geriatricclinic: A randomized controlled trial. Vajira Med J2020;64:235-342.

Srinonprasert V, Kajornkijaroen A, Bangchang PN,Wangtrakuldee G, Wongboonsin J, Kuptniratsaikul V,et al. A survey of opinions regarding wishes towardthe end-of-life among Thai elderly. J Med Assoc Thai2014;97 Suppl 3:S216-22.

Spoelhof GD, Elliott B. Implementing advancedirectives in office practice. Am Fam Physician2012;85:461-6.

Daniel WW. Biostatistics: A foundation of analysis inthe health sciences. 6th ed. New York: John Wiley andSons; 1995. https://doi.org/10.2307/2533362

Chung RY, Wong EL, Kiang N, Chau PY,Lau JYC,Wong SY, et al. Knowledge, attitudes, and preferencesof advance decisions, end-of-life care, and place ofcare and death in Hong Kong. A population-basedtelephone survey of 1067 adults. J Am Med Dir Assoc2017;18:367.e19-27. https://doi.org/10.1016/j.jamda.2016.12.066 PMid:28214237

Chan CWH, Wong MMH, Choi KC, Chan HYL,Chow AYM, Lo RSK, et al. Prevalence, perception, andpredictors of advance directives among Hong KongChinese: A population-based survey. Int J Environ ResPublic Health 2019;16:365. https://doi.org/10.3390/ijerph16030365 PMid:30696082 PMCid:PMC6388376

Laranjeira C, Dixe MDA, Gueifão L, Caetano L,Passadouro R, Querido A. Awareness and attitudestowards Advance Care Directives (ACDs): An onlinesurvey of Portuguese adults. Healthcare (Basel)2021;9:648. https://doi.org/10.3390/healthcare9060648 PMid:34072558 PMCid:PMC8227883

White BP, Willmott L, Tilse C, Wilson J, Ferguson M,Aitken J, et al. Prevalence of advance care directivesin the community: A telephone survey of threeAustralian States. Intern Med J 2019;49:1261-7. https://doi.org/10.1111/imj.14261 PMid:30785233

O'Sullivan R, Mailo K, Angeles R, Agarwal G. Advancedirectives: Survey of primary care patients. Can FamPhysician 2015;61:353-6.

Rao JK, Anderson LA, Lin FC, Laux JP. Completion ofadvance directives among U.S. consumers. Am J PrevMed 2014;46:65-70. https://doi.org/10.1016/j.amepre.2013.09.008 PMid:24355673 PMCid:PMC4540332

Teixeira AA, Hanvey L, Tayler C, Barwich D, Baxter S,Heyland DK. What do Canadians think of advancedcare planning? Findings from an online opinion poll.BMJ Support Palliat Care 2015;5:40-7. https://doi.org/10.1136/bmjspcare-2013-000473 PMid:24644188 PMCid:PMC4345810

De Panfilis L, Rossi PG, Mazzini E, Pistolesi L,Ghirotto L, Noto A, et al. Knowledge, opinion, andattitude about the Italian law on advance directives:A population-based survey. J Pain Symptom Manage2020;60:906-14.e4. https://doi.org/10.1016/j.jpainsymman.2020.06.020 PMid:32619672

Ni P, Wu B, Lin H, Mao J. Advance directives andend-of-life care preferences among adults in Wuhan,China: A cross-sectional study. BMC Public Health2021;21:2042. https://doi.org/10.1186/s12889-021-12046-3 PMid:34749682 PMCid:PMC8574939

Raijmakers NJ, Rietjens JA, Kouwenhoven PS,Vezzoni C, van Thiel GJMW, van Delden JJM, et al.Involvement of the Dutch population in advance careplanning:Across-sectional survey. J Palliat Med2013;16:1055-61. https://doi.org/10.1089/jpm.2012.0555 PMid:23767949

Rurup ML, Onwuteaka-Philipsen BD, van der HeideA, van der Wal G, Deeg DJ. Frequency and determinantsof advance directives concerning end-of-life care inthe Netherlands. Soc Sci Med 2006;62:1552-63. https://doi.org/10.1016/j.socscimed.2005.08.010 PMid:16162380

Nishimura A, Mueller PS, Evenson LK, Downer LL,Bowron CT, Thieke MP, et al. Patients who completeadvance directives and what they prefer. Mayo ClinProc 2007;82:1480-6. https://doi.org/10.1016/S0025-6196(11)61091-4 PMid:18053455

Lee JE, Shin DW, Son KY, Park HJ, Lim JY , Song MS ,et al. Factors influencing attitudes toward advancedirectives in Korean older adults. Arch Gerontol Geriatr2018;74:155-61. https://doi.org/10.1016/j.archger.2017.10.008 PMid:29112876

Downloads

Published

2023-09-13

How to Cite

1.
Manomaipiboon B, Wongvitvichot S, Sumanasrethakul C, Sutjakul B, Anantanupong O, Sae-tang S, Sutthimethakorn S. Attitudes toward end-of-life care and advance directives: a prospective survey in a family medicine clinic, Bangkok, Thailand. Chula Med J [Internet]. 2023 Sep. 13 [cited 2024 Nov. 22];67(4):287-96. Available from: https://he05.tci-thaijo.org/index.php/CMJ/article/view/710