Predictors of Agreement With Writing Advance Directives Among Older Korean Adults

PURPOSE

To determine the predictors of agreement with writing advance directives (ADs) among older Korean adults.

DESIGN

This was a secondary analysis of a study that compared the differences in knowledge, experience, and preference about ADs between community and facility-dwelling older adults. Data were collected through self-reported questionnaires. In this study, after 25 cases were excluded from the original sample (N = 181) for incomplete data, a sample of 156 was analyzed using multiple logistic regression analysis.

RESULTS

Older adults' experiences with having thought about life-sustaining treatments, odds ratio (OR) = 4.02, 95% confidence interval (CI) [1.56, 10.38], agreements with legalization of ADs, OR = 4.68, 95% CI [1.69, 12.96], and wishes to obtain information about medical status, OR = 3.78, 95% CI [1.66, 8.64], were identified as the predictors of agreement with writing ADs.

IMPLICATIONS FOR PRACTICE

Discussion channels and educational programs about ADs should be developed for older Korean adults.

Experience of advance directives in a hospice center

To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.