Advance Directives and Factors Associated with the Completion in Patients with Heart Failure

JinShil Kim, Mi-Seung Shin, Albert Youngwoo Jang, Shinmi Kim, Seongkum Heo, EunSeok Cha and Minjeong An
Additional contact information
JinShil Kim: College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, Korea
Mi-Seung Shin: Division of Cardiology, Gil Medical Center, Department of Internal Medicine, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea
Albert Youngwoo Jang: Division of Cardiology, Gil Medical Center, Department of Internal Medicine, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea
Shinmi Kim: Department of Nursing, Changwon National University, 20 Changwondaehakro, Euichanggu, Kyungsangnamdo, Changwon 51140, Korea
Seongkum Heo: Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA
EunSeok Cha: College of Nursing, Chungnam National University, 266 MunWharo, Junggu, Daejeon 35015, Korea
Minjeong An: College of Nursing, Interdisciplinary Program of Arts & Design Technology, Chonnam National University, 160 Baekseoro, Donggu, Gwangju 61469, Korea

IJERPH, 2021, vol. 18, issue 4, 1-12

Abstract: Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred ( n = 15) followed by avoiding family burden ( n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.

Keywords: heart failure; advance directive; prognosis; advance care planning; palliative care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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