Advance Directives in the Emergency Department – a Systematic Review of the Status Quo

Abstract

Abstract Background Providing individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW), e.g., in the form of advance directives, can guide clinicians in making end-of-life decisions that respect the patient’s wishes and autonomy. However, these are hindered by limited availability in emergency settings.Objective This systematic review aims to congregate existing data on DPW possesion and availability in the emergency department (ED) as well as contributing factors.Methods We searched the MEDLINE database (PubMed) in October 2021. All publications that provided primary quantitative data on DPW in the ED were assessed, culminating in a total of 16 studies included in the analysis. Most (n = 9) were from the US, followed by Australia (4), Germany (1), Canada (1) and Switzerland (1). Publication dates ranged from 1996 to 2020.Results In the general adult population presenting to the ED, 19.9–27.0% of patients possessed some variation of DPW, fewer than 3.2% had it available on presentation. In older people, possession rates (7.9–51.9%) as well as availability (1.7–48.8%) varied widely. The following variables were identified as positive predictors for DPW possession: older age, poorer overall health and presence of comorbidities, as well as several sociodemographic factors, such as female gender, having children, being in a relationship and higher level of education.Conclusion Possession and availability of DPW among ED patients was low in general and even in the older population mostly below 50%. While we were able to gather data on prevalence and predictors, we believe that further research is needed to explore the quality of DPW and possible public health measures to encourage patients to document their healthcare wishes.