Frequency and determinants of advance directives concerning end-of-life care in The Netherlands

Background: Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. Objective: Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. Design/Setting/Participants: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. Measurements: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. Results: Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives −0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home −0.60(95% CI: 1.0.5-0.72). Conclusion: Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.

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Decision Making About End of Life Care: Advance Directives, Durable Power of Attorney for Healthcare, and Talking with Patients with Heart Disease About Dying

End-of-Life Care in Cardiovascular Disease ◽

10.1007/978-1-4471-6521-7_2 ◽

2014 ◽

pp. 21-32

Author(s):

Craig Tanner

Keyword(s):

Decision Making ◽

Heart Disease ◽

End Of Life ◽

Advance Directives ◽

End Of Life Care ◽

Life Care ◽

Power Of Attorney ◽

Durable Power Of Attorney

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Preferences for Advance Directives in Korea

Nursing Research and Practice ◽

10.1155/2012/873892 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

So-Sun Kim ◽

Won-Hee Lee ◽

JooYoung Cheon ◽

Jung-Eun Lee ◽

KiSun Yeo ◽

...

Keyword(s):

End Of Life ◽

Advance Directives ◽

End Of Life Care ◽

Healthcare Providers ◽

Tube Feeding ◽

Life Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Korean People ◽

End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

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Survey of End-of-Life Care Guidelines and Advance Directives

PsycTESTS Dataset ◽

10.1037/t24216-000 ◽

2013 ◽

Author(s):

Yayoi Takezako ◽

Shizukiyo Ishikawa ◽

Kajii

Keyword(s):

End Of Life ◽

Advance Directives ◽

End Of Life Care ◽

Life Care ◽

Care Guidelines

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End-of-Life Care in the Netherlands and the United States: A Comparison of Values, Justifications, and Practices

Caring for Patients at the End of Life ◽

10.1093/acprof:oso/9780195139402.003.0014 ◽

2001 ◽

pp. 203-221

Author(s):

Timothy E. Quill

Keyword(s):

United States ◽

The Netherlands ◽

End Of Life ◽

End Of Life Care ◽

The United States ◽

Life Care

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Advance directives: the emerging body of research

American Journal of Critical Care ◽

10.4037/ajcc1999.8.1.514 ◽

1999 ◽

Vol 8 (1) ◽

pp. 514-519 ◽

Cited By ~ 34

Author(s):

BB Ott

Keyword(s):

End Of Life ◽

Advance Directives ◽

End Of Life Care ◽

Demographic Data ◽

The Body ◽

Future Research ◽

Computer Search ◽

Life Care ◽

Study Selection ◽

New Procedures

BACKGROUND: With the passage of the Patient Self-Determination Act in 1990, new procedures and documents became available for planning end-of-life care. These new procedures and documents are now being examined scientifically. OBJECTIVE: To review existing research on the use of advance directives. DATA SOURCES: Computer search using Grateful Med software from the National Library of Medicine with MEDLINE and BIOETHICSLINE databases. STUDY SELECTION: Studies that showed an emerging consensus or reported vastly differing results were selected. Selected studies examined these specific areas: demographic data on patients with advance directives, completion rates, capacity to complete, patients' preferences, stability of patients' decisions over time, treatment choices, proxy decision makers, treatment provided, and cost. RESULTS: The body of important research about advance directives is growing. A profile of their clinical utility is emerging. CONCLUSIONS: The research done so far can stimulate future research and can begin to suggest possible changes in practice. However, the body of research is not yet large enough or well controlled enough to answer conclusively many of the questions about planning of end-of-life care.

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End-of-Life Care in the Netherlands and the United States: A Comparison of Values, Justifications, and Practices

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100007805 ◽

1997 ◽

Vol 6 (2) ◽

pp. 189-204 ◽

Cited By ~ 10

Author(s):

Timothy E. Quill ◽

Gerrit Kimsma

Keyword(s):

United States ◽

The Netherlands ◽

End Of Life ◽

End Of Life Care ◽

Assisted Suicide ◽

Ethical Climate ◽

The United States ◽

Policy Implications ◽

Life Care ◽

Physician Assisted Suicide

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries.

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