Author:
Koenig Julia Felicitas Leni,Asendorf Thomas,Simon Alfred,Bleckmann Annalen,Truemper Lorenz,Wulf Gerald,Overbeck Tobias R.
Abstract
AbstractBackgroundThe advance directive represents patients’ health care choices and fosters patients’ autonomy. Nevertheless, understanding patients’ wishes based on the information provided in advance directives remains a challenge for health care providers. Based on the ethical premises of positive obligation to autonomy, an advanced directive that is disease-centred and details potential problems and complications of the disease should help health care providers correctly understand patients’ wishes. To test this hypothesis, a pilot-study was conducted to investigate whether physicians could make the correct end-of-life decision for their patients when patients used a disease-centred advance directive compared to a common advance directive. Material and methodsA randomised, controlled, prospective pilot study was designed that included patients with non-small cell lung cancer (NSCLC) stage VI from the Department of Haematology and Medical Oncology, University Medical Centre, Goettingen. Patients were randomised into intervention and control groups. The control group received a common advance directive, and the intervention group received a disease-centred advance directive. Both groups filled out their advance directives and returned them. Subsequently, patients were asked to complete nine medical scenarios with different treatment decisions. For each scenario the patients had to decide whether they wanted to receive treatment on a 5-point Likert scale. Four physicians were given the same scenarios and asked to decide on the treatment according to the patients’ wishes as stated in their advance directives. The answers by patients and physicians were then compared to establish whether physicians had made the correct assumptions.ResultsRecruitment was stopped prior to reaching anticipated sample target. 15 patients with stage IV NSCLC completed the study, 9 patients were randomised into the control group and 6 patients in the intervention group. A total of 135 decisions were evaluated. The concordance between physicians’ and patients’ answers, was 0.83 (95%-CI 0.71–0.91) in the intervention group, compared to 0.60 (95%-CI 0.48–0.70) in the control group, and the difference between the two groups was statistically significant (p = 0.005).ConclusionThis pilot study shows that disease-centred advance directives help physicians understand their NSCLC patients’ wishes more precisely and make treatment choices according to these wishes.Trial registrationThe study is registered at the German Clinical Trial Register (no. DRKS00017580, registration date 27/08/2019).
Funder
Georg-August-Universität Göttingen
Publisher
Springer Science and Business Media LLC
Reference35 articles.
1. Buiar PG, Goldim JR. Barriers to the composition and implementation of advance directives in oncology: a literature review. Ecancermedicalscience. 2019;13:974.
2. Zwakman M, van Delden JJM, Caswell G, et al. Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention: insights gained from the ACTION trial. Support Care Cancer. 2020;28:1513–22.
3. Beauchamp TL and Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford Univ. Press; 2013.
4. Quante M. Personales Leben und menschlicher Tod: Personale Identität als Prinzip der biomedizinischen Ethik. Vollst. zugl.: Münster (Westfalen), Univ., Habil.-Schr., 2001. 1. Aufl., Originalausg. Frankfurt am Main: Suhrkamp, 2002.
5. Quante M. Menschenwürde und personale Autonomie: Demokratische Werte im Kontext der Lebenswissenschaften. Unverändertes eBook der 1. Aufl. von 2014. Hamburg: Felix Meiner Verlag, 2014.
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献