Title

Factors that Influence Advance Directives Completion amongst Terminally Ill Patients at AKUHN

Date of Award

5-30-2016

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Asim Jamal

Second Supervisor/Advisor

Prof. Gerald O. Yonga

Third Supervisor/Advisor

Dr. John Weru

Department

Internal Medicine (East Africa)

Abstract

Background: An advance directive is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves, and which is then used to guide decisions on life-sustaining treatment in the event that they become incapacitated. Advance directives can take one of four forms: a living will, a limitation of care document, a do-not-resuscitate order, and an appointment of a surrogate by durable power of attorney. The completion rate of advance directives varies from region to region, and it is influenced by different patient, caregiver, legal, institutional, cultural, and religious factors.

Objectives: To determine the proportion of terminally ill patients at AKUHN with advance directives and to identify the factors that influence completion of advance directives amongst terminally ill patients at AKUHN.

Methods: The study was a retrospective survey. All available records of terminally ill patients seen at AKUHN between July 2010 and December 2015, and that met the inclusion criteria were included in the study.

Results: In total, 216 records of terminally ill patients met the inclusion criteria; 89 were of patients that had advance directives and 127 were of those that did not have advance directives. The proportion of terminally ill patients that had completed advance directives was 41.2%. The factors that were associated with completion of advance directives on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status, the medical specialty taking care of the patient, the caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient’s functional impairment were the only factors with statistically significant association with completion of AD.

Conclusions: The proportion of terminally ill patients that had advance directives in their medical records was significant but the majority of terminally ill patients did not have advance directives. Most of the factors associated with advance directives completion mirrored those seen in other regions of the world, and discussion between patient and their physician and patient’s functional impairment were the factors independently associated with completion of advance directives.

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