Do advance directive attitudes and perceived susceptibility and end-of-life life-sustaining treatment preferences between patients with heart failure and cancer differ?

• Published in: PloS one Vol. 15; no. 9; p. e0238567
• Main Authors: Kim, JinShil, Choi, Jiin, Shin, Mi-Seung, Kim, Miyeong, Seo, EunJu, An, Minjeong, Shim, Jae Lan, Heo, Seongkum
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08-09-2020; Public Library of Science (PLoS)
• Subjects: Advance directives; Advance directives (Medicine); Advance Directives - legislation & jurisprudence; Aged; Attitudes; Behavior; Breast cancer; Cancer; Cancer patients; Cancer therapies; Cardiac patients; Cardiopulmonary resuscitation; Caregivers; Comparative analysis; Confidence intervals; Congestive heart failure; CPR; Decision making; Diagnostic systems; Disease; End of life; Female; Gastric cancer; Health attitudes; Health care; Heart failure; Heart Failure - therapy; Hemodialysis; Hospice care; Hospitals; Humans; Life Support Care - legislation & jurisprudence; Likert scale; Male; Medical diagnosis; Medicine and Health Sciences; Mental disorders; Middle Aged; Neoplasms - therapy; Nursing; Patient Preference - legislation & jurisprudence; Questionnaires; Resuscitation; Surveys; Susceptibility; Terminal Care - legislation & jurisprudence; Ventilation; South Korea; United States > US; Georgia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0238567

There is limited evidence on the relationships of preference for end-of-life life-sustaining treatments [LSTs] and diagnostic contexts like heart failure [HF] or cancer, and patient attitudes toward and perceived susceptibility to use advance directives [ADs]. Thus, this study aimed to compare attitudes and perceived susceptibility between HF patients and community-dwelling patients with cancer, and examine the associations of these variables with their preference for each LST (cardiopulmonary resuscitation [CPR], ventilation support, hemodialysis, and hospice care). Secondary data were obtained from 36 outpatients with HF (mean age, 65.44 years; male, 69.4%) and 107 cancer patients (mean age, 67.39 years; male, 32.7%). More patients with HF preferred CPR than cancer patients (41.7% and 15.9%, χ2 = 8.88, P = 0.003). Attitudes and perceived susceptibility were similar between the two diagnostic cohorts. HF patients and those with more positive attitudes had greater odds of preferring CPR (odds ratio [OR] = 3.02, confidence interval [CI] = 1.19, 7.70) and hospice care (OR = 1.14, CI = 1.06, 1.23), respectively. HF diagnosis and AD attitudes increased the preference for CPR and hospice care, respectively. This suggests that it is important to gain positive attitudes toward ADs and consider diagnostic context to facilitate informed decision-making for LSTs.