Factors influencing the completion of advance directives in cancer patients: a descriptive survey

TL;DR

This study explores why some cancer patients complete advance directives, finding that factors like age, education, and readiness for death play a role.

Contribution

The study identifies specific demographic and psychological factors associated with advance directive completion among cancer patients in South Korea.

Findings

Patients aged 60-69 and under 60 were less likely to complete advance directives compared to those aged 70 and older.

Lower education levels and prior experience discussing life-sustaining treatment withdrawal were strongly linked to higher AD completion rates.

Increased psychological and formal readiness for death significantly increased the likelihood of completing an advance directive.

Abstract

This study aimed to investigate the factors associated with the completion of advance directives among cancer patients.

Despite legislation to support end-of-life decision-making, the completion rate of advance directives (AD) in South Korea remains low. In many cases, family members make end-of-life decisions on behalf of patients. To promote patient autonomy and reduce family burden, early initiation of AD discussions is essential.

Survey data on demographics and factors related to AD completion were collected through a written survey administered by the researchers from 148 cancer patients at a tertiary hospital between November 2, 2023, and March 10, 2024. Data analysis included frequency, percentage, mean, standard deviation, χ²-test, independent t-test, Pearson’s correlation coefficient, and multivariate logistic regression.

Compared to patients aged 70 and older, those under 60 were 0.18 times as likely, and those aged 60 to 69 were 0.27 times as likely, to complete an AD. Patients with a middle school education or less were 12.46 times more likely to complete an AD than those with higher education levels. Having prior experience discussing the withdrawal of life-sustaining treatment during the death of a loved one increased the likelihood of completing an AD by 18.64 times. Additionally, each 1-point increase in psychological and formal Readiness for Death was associated with a 6.78-fold increase in the likelihood of completing an AD. Age, education level, prior experience, and particularly Readiness for Death were found to be associated with AD completion among cancer patients.

AD completion among cancer patients was associated with age, education level, prior discussion of LST withdrawal, and Readiness for Death. These findings highlight factors that may inform future interventions to support patient autonomy via increased uptake of ADs.