The proportions of males and females in our study were They found that men preferred death over futile care, and that men addressed only the functional aspects of end of life care. This contrasted with women who addressed other aspects as well [ 22 ]. In our study, there was no significant difference between proportions of males and females who completed AD.
The majority of patients in our study had obtained tertiary level education However, education level attained did not have a statistically significant association with completion of AD in our study. Mezey et al. In another hospital-based study in Thailand, Sittisombut et al. In their study, as was in ours, there was no correlation between education and completion of AD [ 11 ]. There are patient factors associated with AD such as knowledge and attitude of patients that we could not study due to the retrospective nature of our study.
There are also aspects of patient-physician relationship important for AD completion that we could not study. The role played by lack of laws on AD in Kenya could also not be studied. However, all these factors are known to play a role in AD completion [ 23 ] [ 24 ]. Despite these limitations, our study shows that the factors associated with AD in Kenya are not different from those reported in the studies done in Western countries.
It also re-demonstates the important role played by physicians in promoting AD use. Despite reporting from a developing country, our study demonstrates good uptake of AD in our hospital amongst terminally ill patients. The proportion of terminally ill patients that had AD in their medical records was significant, however, most terminally ill patients did not have AD. Most of the factors associated with AD completion were the same as those seen in other regions of the world. Among them, discussion between a patient and their physician and functional impairment of the patient were the factors independently associated with completion of AD.
We conclude that physician involvement and early discussion with the patients are key components associated with AD completion. Similar but larger studies, done prospectively and incorporating patients from public hospitals, could identify other factors that could be improved to enhance completions of AD in our population.
However, some factors known to influence AD completion in the United States of America and Western European countries such as age did not have a correlation with AD in our study, perhaps reflecting a relatively younger population in our setup. To improve uptake of AD in our setting, we should encourage more physician - patient discussion as this was the main modifiable influence of AD uptake in our setting. Prevalence and predictors of advance directives in Australia.
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In considering treatment decisions, your personal values are key. Is your main desire to have the most days of life? Or, would your focus be on quality of life, as you see it?
What if an illness leaves you paralyzed or in a permanent coma and you need to be on a ventilator? Would you want that? What makes life meaningful to you? If your heart stops or you have trouble breathing, would you want to undergo life-saving measures if it meant that, in the future, you could be well enough to spend time with your family?
Would you be content if the emergency leaves you simply able to spend your days listening to books on tape or gazing out the window? For some people, staying alive as long as medically possible, or long enough to see an important event like a grandchild's wedding, is the most important thing. An advance directive can help to make that possible. Others have a clear idea about when they would no longer want to prolong their life. An advance directive can help with that, too.
Your decisions about how to handle any of these situations could be different at age 40 than at age Or, they could be different if you have an incurable condition as opposed to being generally healthy. An advance directive allows you to provide instructions for these types of situations and then to change the instructions as you get older or if your viewpoint changes. There are two main elements in an advance directive—a living will and a durable power of attorney for health care. There are also other documents that can supplement your advance directive.
You can choose which documents to create, depending on how you want decisions to be made. These documents include:. Living will. A living will is a written document that helps you tell doctors how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment. In a living will, you can say which of the procedures described in the Decisions That Could Come Up section you would want, which ones you wouldn't want, and under which conditions each of your choices applies.
Durable power of attorney for health care. A durable power of attorney for health care is a legal document naming a health care proxy, someone to make medical decisions for you at times when you are unable to do so. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. This means that he or she will be able to decide as you would when treatment decisions need to be made.
A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, like a serious auto accident. Some people are reluctant to put specific health decisions in writing. For them, naming a health care agent might be a good approach, especially if there is someone they feel comfortable talking with about their values and preferences.
A named proxy can evaluate each situation or treatment option independently. Other advance care planning documents. You might also want to prepare documents to express your wishes about a single medical issue or something not already covered in your advance directive.
A living will usually covers only the specific life-sustaining treatments discussed earlier. You might want to give your health care proxy specific instructions about other issues, such as blood transfusion or kidney dialysis. This is especially important if your doctor suggests that, given your health condition, such treatments might be needed in the future. A DNR do not resuscitate order tells medical staff in a hospital or nursing facility that you do not want them to try to return your heart to a normal rhythm if it stops or is beating unsustainably using CPR or other life-support measures.
Even though a living will might say CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your bed might avoid confusion in an emergency situation. Without a DNR order, medical staff will make every effort to restore your breathing and the normal rhythm of your heart.
A similar document, called a DNI do not intubate order, tells medical staff in a hospital or nursing facility that you do not want to be put on a breathing machine. An advance directive lets your health care team and loved ones know what kind of health care you want, or who you want to make decisions for you when you can't. An advance directive can help you think ahead of time about what kind of care you want. This option allows you to name another person, such as your spouse or adult child, to make medical decisions for you if you are unable to do so.
A medical power of attorney is not the same as a power of attorney that allows another person to handle your financial or legal affairs. Choosing the right person to act on your behalf regarding important medical decisions is vital.
Even if you have other documents covering aspects of your care, not every situation can be anticipated. The person you choose to represent you should meet the following criteria:. Advance directives are an important part of health care. No one can predict when unexpected medical situations will happen.
An advance directive helps loved ones, and medical personnel make important decisions during a crisis. Having an advance directive in place ensures that your wishes regarding your health care are carried out, even when you're unable to make your wishes known.
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