An Exploratory Research On Advance Directives For Advanced Cancer Patients

BackgroundRecently, with the development of the society and human civilization, and the increasing international cooperations, patients’consciousness of human right has strengthened rapidly and their life values also become more and more rational. However, excessive medical treatments against patients’own will still happen frequently, which not only lead to patients’painful death, make the relatives of patients undertake huge ethical pressure, and also cause the waste of limited medical source and its unfair distribution. Advance directives (AD) can improve the phenomena to some extent. AD is a legal will that protect patients’right and help them die a good death, which comply with the value of palliative care. AD let patients make medical decision and set the durable power of attorney in medical care when they have complete behavioral capacity in case of some unexpected situations like coma and so on. Nowadays, AD in some countries like USA and Tai Wan region of our country becomes legal and conventional. Many specialists in mainland of China are calling on the generalization of AD, while related researches are very limitedObjectiveTo explore the possibilities of the implementation of AD for advanced cancer patients and offer some advices to the related medical policy making in palliative care area.MethodThere are two stages in the study:1Investigates the attitude on AD and related behavioral intentions of advanced cancer patients, relatives of advanced cancer patients and oncology medical staffs with self-designed questionnaires.2Interview advanced cancer patients, relatives of advanced cancer patients and oncology medical staffs to understand more about their attitudes about AD and influencing factorsResult1The investigation of advanced cancer patients, relatives of advanced cancer patients and oncology medical staffs about their attitudes on advance directives.(1)75advanced cancer patients,112relatives of advanced cancer patients and109oncology medical staffs were investigated.18.7%of the patients and19.6%of the relatives believed in Buddhism.81.7%of the medical staffs had dealt with patients’death, while only10.1%had received palliative care training.(2) The three groups of people could accept AD. The medical staff had the most positive attitude on AD, the relative group was the most conservative, and the difference has statistical significance (P<0.05)(3) Education background and religion could significantly affect the attitudes of patients on AD, and those who had a higher education level and some religion (mainly Buddhism) were more positive to AD. Department and marriage significantly affected the attitudes of medical staff, and those whose patients were more serious and had married could much easily accept AD.2Depth interviews of advanced cancer patients, relatives of advanced cancer patients and oncology medical staffs about their attitudes on advance directives and related behavioral intentions(1) Patients and relatives could recognize the strengths of AD, while they also had some worries and misunderstandings to its implementation.(2) Most patients thought that whether implementing CPR or not should be decided by the state of the illness; pressure from others and their own conscience stirs were the relatives’main reasons to choose CPR.(3) The medical staff wished to create a more mature circumstance by improving policies, making life education, developing palliative care and so on to implement AD.Conclusion(1) Most advanced cancer patients, the relatives of advanced cancer patients and oncology medical staffs can accept AD. While some patients and relatives had some worries and misunderstandings to it, some medical staffs think that AD’s implementation should be in a more mature circumstance.(2) Patients who have a higher education level and some religion (mainly Buddhism) are more positive to AD, pressure from others and the fear that lead to patients’negative emotion of are the main reasons that relatives deny AD; medical staff should lead to generalize and implement AD.(3)AD is much needed in mainland of China, while the circumstance is not mature enough to implement it and should have a localization process.