The effectiveness of advance directive for terminal care in terminally ill patients in Chiang Mai University Hospital

Abstract

Objectives: To assess the effectiveness of advance directives (ADs) for terminalcare in terminally ill patients and to determine whether ADs could be initiated and wereaccepted for terminal care in terminal illnesses in CMU Hospital. Research design:Non-randomized control study and after-only nonequivalent control group design.Outcome: Three outcomes were measured; CPR/NR event; discharge; and death (inhospital and at one month).Results: ADs was acceptable and applicable in this setting. Generally, therewere no significant differences by baseline demographic and clinical characteristicbetween the control and the intervention groups, the exceptions were for the CPC scoreand the number of patients with end stage liver disease. However, these characteristicswere homogeneity after adjusted with Matel Haenzel Chi square. Therefore, it waspossible to conclude that AD was effective to reduce futile CPR and dead rate in thepatients who received ADs as compared to the control.Eighty pairs (60.6%) of subjects and surrogate preferred to employ AD for CPRorally. The concordance in decision-making was 71.3%. Data suggested that ADs couldbe initiated for patients with any condition. However, it was accepted only for DNR, noother treatment were withdrawn or withheld from the patients. In addition, theinformation regarding survival chance after CPR and the worst condition post CPR candramatically decrease their preference for CPR.Conclusion: The results must be qualified in several respects. This study provedthat AD is applicable for individual who have low education, low socioeconomic status,as well as rural dwellers, but the method of implementation must be adjusted accordingto the patient’s perceptions and this method is unique. In this study, only few variableswere associated with a patient’s preference for terminal care. Therefore, ourinvestigation suggests that the AD preference of patients for each procedure should beassessed individually with adequate information.