Medline ® Abstracts for References 25-27
of 'Advance care planning and advance directives'
A critical review of advance directives in Germany: attitudes, use and healthcare professionals' compliance.
Evans N, Bausewein C, Meñaca A, Andrew EV, Higginson IJ, Harding R, Pool R, Gysels M, project PRISMA
Patient Educ Couns. 2012 Jun;87(3):277-88. Epub 2011 Nov 23.
OBJECTIVE: Recent legal changes in Germany make non-compliance with advance directives (ADs) a criminal offence. This article assesses the evidence on attitudes towards, use of, and physician compliance with ADs in Germany.
METHODS: Critical review: studies on ADs, identified from a systematic review of culture and end-of-life care in Germany (11 electronic databases, 3 journals, reference lists, and grey literature), were included. An interpretative synthesis of findings revealed cross-cutting themes.
RESULTS: Thirty-two studies (1996-2009) were identified. Key themes were: awareness; utilization; compliance; and bindingness of ADs. There was a positive trend between awareness of ADs and study publication date. Use varied between patient groups (0.3-62%) and was low amongst the general population (2.5-10%). Fears about ADs' purpose and possible abuse were identified. Physician discomfort in discussing ADs and non-compliance were reported. Physicians preferred legally binding ADs, though conflicting results were reported for patients' desired level of bindingness.
CONCLUSION: Although there is increasing awareness of ADs in Germany, there remains low use, poor communication, fears of abuse, some non-compliance and contradictory evidence regarding desired bindingness.
PRACTICAL IMPLICATIONS: Although legal changes will hopefully improve compliance, low awareness, communication difficulties and uncertainties surrounding ADs must be addressed if use is to increase.
Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - Universitat de Barcelona), Barcelona, Spain. firstname.lastname@example.org
Advance directives in the Netherlands: an empirical contribution to the exploration of a cross-cultural perspective on advance directives.
van Wijmen MP, Rurup ML, Pasman HR, Kaspers PJ, Onwuteaka-Philipsen BD
Bioethics. 2010 Mar;24(3):118-26.
RESEARCH OBJECTIVE: This study focuses on ADs in the Netherlands and introduces a cross-cultural perspective by comparing it with other countries.
METHODS: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%.
RESULTS: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive (AED, 64%). Both low education and the presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD.
DISCUSSION: This study shows that the subjects of palliative care and end-of-life-decision-making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings.
EMGO Institute for Health and Care Research, VU University Medical Center-Public and Occupational Health, van der Boechorststraat 7, Amsterdam, Netherlands. email@example.com
Advance care planning and the older patient.
Aw D, Hayhoe B, Smajdor A, Bowker LK, Conroy SP, Myint PK
QJM. 2012 Mar;105(3):225-30. Epub 2011 Nov 10.
Making treatment decisions for older people is difficult, because of the complex interplay of their multiple co-morbidities, but also because of the fine balance of risks vs. benefit in any chosen management plan. This becomes even more difficult when they lose the capacity to tell us what they want, and often in such situations we have to rely on information from others in order to make decisions based on their best interests. Advance care planning should help with making these decisions clearer, based on the documented preferences of what the patient would have wanted while capacity was still present. However, such documents are still very rarely used, and even if they are, health-care professionals are often wary of them for the multitude of ethical and legal problems that can arise.
Norwich Medical School, Chancellors Drive, University of East Anglia, Norwich, NR4 7TJ, Norfolk, UK.