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Supportive Care in Cancer
Published in: Supportive Care in Cancer 2/2017

01-02-2017 | Original Article

Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers

Authors: Julie C. McDonald, Jeanne M. du Manoir, Nanor Kevork, Lisa W. Le, Camilla Zimmermann

Published in: Supportive Care in Cancer | Issue 2/2017

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Abstract

Purpose

The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer.

Methods

Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities. Multinomial logistic regression analysis identified factors associated with the timing of AD completion (pre-cancer, post-cancer, or not at all).

Results

Two hundred patients were enrolled, with 193 surveys available for analysis. ADs were completed in 55 % (106/193) of patients, including a living will in 33 % (63/193), a power of attorney in 49 % (95/193), and a do-not-resuscitate (DNR) designation in 18 % (35/193). Most patients (53 %) had completed an AD before being diagnosed with cancer. Higher income (p = 0.02) and age (p = 0.004) were associated with AD completion pre-cancer diagnosis; discussion of end-of-life care (p = 0.02) and palliative care referral (p < 0.0001) were associated with AD completion post-cancer diagnosis.

Conclusions

This study demonstrates that different factors may influence the completion of ADs before and after a diagnosis of cancer and highlights the potential for early palliative care to impact the completion of ADs in patients with advanced cancer who are undergoing active cancer treatment.
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Metadata
Title
Advance directives in patients with advanced cancer receiving active treatment: attitudes, prevalence, and barriers
Authors
Julie C. McDonald
Jeanne M. du Manoir
Nanor Kevork
Lisa W. Le
Camilla Zimmermann
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 2/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-016-3433-6

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