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Factors That Influence Attitudes toward Advance Directives among Female Cancer Patients

  • Aeri Kim (Department of Nursing, Seoul Soonchunhyang University Hospital) ;
  • Kisook Kim (Department of Nursing, Chung-Ang University)
  • Received : 2023.02.26
  • Accepted : 2023.05.08
  • Published : 2023.06.01

Abstract

Purpose: This study aimed to identify attitudes toward advance directives (ADs) among female cancer patients and factors related to ADs. Methods: The study was conducted at a university hospital in Seoul from September 19, 2020, to January 20, 2021. The participants were 153 patients diagnosed with gynecological cancer or breast cancer. Data were collected using questionnaires and included general characteristics, disease- and AD-related characteristics, knowledge and attitudes about ADs, and attitudes about dignified death. Data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results: Only 2% of the participants completed ADs. The mean score for attitudes toward ADs was 3.30, indicating a positive knowledge and attitude toward dignified death. The factors related to attitudes toward ADs were attitudes toward dignified death (𝛽=0.25, P=0.001), experience discussing life-sustaining treatment (𝛽=0.17, P=0.037), preferred time to have a consultation about ADs (𝛽=0.19, P=0.046), intention to write ADs (𝛽=0.15, P=0.038), and Eastern Cooperative Oncology Group Performance Status (𝛽=-0.37, P<0.001). The explanatory power of these variables for attitudes toward ADs was 38.5%. Conclusion: Overall, patients preferred to have a consultation about ADs when they were still active, mentally healthy, and able to make decisions. Education about ADs should be provided to patients on the first day of hospitalization for chemotherapy or while awaiting treatment in an outpatient setting so patients can write ADs and discuss them with family and friends.

Keywords

References

  1. OECD.Stat. Health status: Causes of mortality [Internet]. Paris: Organisation for Economic Co-operation and Development; 2022 [cited 2023 Feb 7]. Available from: https://stats.oecd.org/index.aspx?queryid=30115.
  2. Lim Y, Kim Y, Yoon H. Quality of life of older cancer patients in comparison with older chronic disease patients and middle-aged cancer patients. Korean J Soc Welf 2013;65:367-93. https://doi.org/10.20970/kasw.2013.65.4.015
  3. Heo DS. Patient autonomy and advance directives in Korea. J Korean Med Assoc 2009;52:865-70. https://doi.org/10.5124/jkma.2009.52.9.865
  4. Gillick MR. Advance care planning. N Engl J Med 2004;350:7-8. https://doi.org/10.1056/NEJMp038202
  5. Kim SM, Hong YS, Hong SW, Kim JS, Kim KS. Development of a Korean version of an advance directive model via cognitive interview. Korean J Hosp Palliat Care 2013;16:20-32. https://doi.org/10.14475/kjhpc.2013.16.1.20
  6. Jeong JH. An introduction to constitutional law. 7th ed. Seoul:Pakyoungsa Co., Ltd;2017. p. 324.
  7. National Agency for Management of Life-Sustaining Treatment [Internet]. Seoul: The Korea National Institute for Bioethics Policy; 2023 [cited 2023 Feb 15]. Available from: https://www.lst.go.kr/main/main.do.
  8. Pfirstinger J, Kattner D, Edinger M, Andreesen R, Vogelhuber M. The impact of a tumor diagnosis on patients' attitudes toward advance directives. Oncology 2014;87:246-56. https://doi.org/10.1159/000363508
  9. McDonald JC, du Manoir JM, Kevork N, Le LW, Zimmermann C. Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers. Support Care Cancer 2017;25:523-31. https://doi.org/10.1007/s00520-016-3433-6
  10. Zheng RJ, Fu Y, Xiang QF, Yang M, Chen L, Shi YK, et al. Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China. Support Care Cancer 2016;24:4097-103. https://doi.org/10.1007/s00520-016-3223-1
  11. Kornblith AB, Powell M, Regan MM, Bennett S, Krasner C, Moy B, et al. Long-term psychosocial adjustment of older vs younger survivors of breast and endometrial cancer. Psychooncology 2007;16:895-903. https://doi.org/10.1002/pon.1146
  12. Park JS, Lee HR. Comparison of distress and body image according to the stages of cancer survivorship in gynecological cancer patients. Asian Oncol Nurs 2014;14:15-22. https://doi.org/10.5388/aon.2014.14.1.15
  13. Payne M. Advance care planning is participative social work practice. Revista Portuguesa de Pedagogia (Psychologica) 2010:105-19.
  14. Ha EJ, Gu MO. Factors affecting intention of signing an advanced directives in cancer patients. J Korean Acad Fundam Nurs 2021;28:121-32. https://doi.org/10.7739/jkafn.2021.28.1.121
  15. Yoo HI, Yi YH. Middle-aged adults' attitudes toward dignified death and advance directives, and knowledge of advance directives. J Korean Clin Nurs Res 2020;26:86-96.
  16. Lee MH, Park YH. Factors influencing attitude toward advance directives of older cancer patients. Korean J Adult Nurs 2015;27:449-58. https://doi.org/10.7475/kjan.2015.27.4.449
  17. Lee HL, Park YH. Attitudes toward advance directives of older adults using senior centers. J Korean Gerontol Nurs 2014;16:160-9. https://doi.org/10.17079/jkgn.2014.16.2.160
  18. Jo KH. Development and evaluation of a dignified dying scale for Korean adults. J Korean Acad Nurs 2011;41:313-24. https://doi.org/10.4040/jkan.2011.41.3.313
  19. Jo KH, An GJ, Kim GM, Kim YJ. Predictive factors for city Dwellers' attitudes toward death with dignity. Korean J Hosp Palliat Care 2012;15:193-204. https://doi.org/10.14475/kjhpc.2012.15.4.193
  20. Kim HJ. Factors influencing attitude toward advance directive in nursing students. J Korean Acad Soc Nurs Educ 2019;25:227-37. https://doi.org/10.5977/jkasne.2019.25.2.227
  21. Seo SY. The knowledge and attitude about the advance directives: focused on the home-based cancer patients registered in community health centers [master's thesis]. Busan: Catholic Univ. of Pusan; 2019. Korean.
  22. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55. https://doi.org/10.1097/00000421-198212000-00014
  23. Nolan MT, Bruder M. Patients' attitudes toward advance directives and end-of-life treatment decisions. Nurs Outlook 1997;45:204-8. https://doi.org/10.1016/S0029-6554(97)90066-X
  24. Der Bundesrepublik. Drittes Gesetz zur Anderung des Betreuungsrechts. Bundesgesetzblatt [Internet]. 2009;48:2286-7 [cited 2023 Apr 23]. Available from: http://www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzeiger_BGBl&jumpTo=bgbl109s2286.pdf. 109s2286.pdf
  25. CanLII. The Health Care Directives and Consequential Amendments Act, SM 1992, c 33 [Internet]. Ottawa, Ontario: Canadian Legal Information Institute; 1992 [cited 2023 Apr 23]. Available from: https://canlii.ca/t/54rq0.
  26. Sun DS, Chun YJ, Lee JH, Gil SH, Shim BY, Lee OK, et al. Recognition of advance directives by advanced cancer patients and medical doctors in hospice care ward. J Hosp Palliat Care 2009;12;20-6. https://doi.org/10.14475/kjhpc.2009.12.1.20
  27. Jang AY, Park JS. Factors influencing quality of life of cancer patients hospitalized in long-term care hospitals. J Korean Gerontol Nurs 2018;20:35-44. https://doi.org/10.17079/jkgn.2018.20.1.35
  28. Jin YJ, Chun JS. Factors influencing the attitudes toward the advanced directives of patients with cancer: Focusing on the psychological, family, and social aspects. Health Soc Welf Rev 2022;42:303-19.
  29. Adams JA, Bailey Jr DE, Anderson RA, Docherty SL. Nursing roles and strategies in end-of-life decision making in acute care: A systematic review of the literature. Nurs Res Pract 2011;2011:527834. Epub 2011 Oct 2.
  30. Kim JA, Cho EY. How the middle-aged women view her own life? JCCT 2015;1:47-68. https://doi.org/10.3233/JCC-150004