Abstract:
BACKGROUND:During the last few decades, patients' rights have been reinforced in many countries by acts of law. Measures now include health care proxies to uphold the doctor-patient relationship and advance directives for end-of-life patients. These could be relevant tools as early as the initial diagnosis of haematological malignancies because of the uncertain disease course. The aim of this research was to assess the factors associated with the designation of a proxy and writing advance directives by patients in a haematology department in France. METHODS:After a specific programme to encourage discussions about end-of-life preferences, we conducted a mixed-methods study comprising retrospective analysis of a random sample of 200 patients' medical records, crossed with a qualitative analysis of the content of advance directives. Statistical analysis was performed by the RKward V 0.6.1 software with 0.05 denoting significance. The study was performed and presented in accordance with the STROBE guidelines. A thematic analysis of the advance directives was performed by two researchers. RESULTS:A total of 197 medical records were evaluable. The mean age of the patients was 66 years (range: 18-91). Nearly 2/3 of them (64.5%) designated a proxy, 6.1% wrote advance directives, and 8.1% and 4.6% expressed a wish to meet a religious representative or a volunteer, respectively. The 2-year survival rate was 78.4% [95%CI: 68.2-90.2]. Patients who wrote advance directives were statistically older (p <0.00025). Patients who wrote an advance directive were more likely to have expressed a wish to meet a religious representative (p <0.001) or a volunteer (p = 0.003). Marital status was a significant factor in appointing a proxy (p = 0.04). CONCLUSIONS:To the best of our knowledge, this is the first paper to identify influencing factors for proxies and advance directives in a homogenous population of patients with haematological malignancies. Most patients chose a proxy. However, despite several training programmes for the carers and a care planning programme, few patients wrote advance directives. Our findings suggest that influencing factors are advanced age and a wish to see a religious representative. This study highlights the importance of oral communication about end-of-life issues between carers, patients and their relatives.
journal_name
BMC Palliat Carejournal_title
BMC palliative careauthors
Trarieux-Signol S,Moreau S,Gourin MP,Penot A,Edoux de Lafont G,Preux PM,Bordessoule Ddoi
10.1186/1472-684X-13-57subject
Has Abstractpub_date
2014-12-11 00:00:00pages
57issn
1472-684Xpii
249journal_volume
13pub_type
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journal_title:BMC palliative care
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pub_type: 杂志文章,随机对照试验
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更新日期:2012-09-20 00:00:00
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journal_title:BMC palliative care
pub_type: 杂志文章
doi:10.1186/1472-684X-12-28
更新日期:2013-08-06 00:00:00
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