Awareness and use of advance directives in the spinal cord injured population

Research was conducted through the use of semi-structured patient interviews. Subjects were recruited through the Saskatchewan branch of the Canadian Paraplegic Association (CPA) and through the clinical practice of the primary investigator. A total of twenty-one patients were interviewed. A qualitative outcome analysis was performed on information collected.

Advance directives (or living wills) serve to communicate the wishes of individuals in the event that they should no longer be capable of making those wishes known. This can include directives on issues such as resuscitation status and withdrawal or withholding of care. The goal of this study was to determine the present level of knowledge and interest of spinal cord injured (SCI) patients on the topic of advance directives, and to determine what specific issues they felt need to be addressed in such a document in this population.

The study was performed in Saskatoon, Saskatchewan, Canada. Although design and analysis were done in a tertiary care centre, the interviews themselves were conducted in the homes of the participants.

The results show that spinal cord injured patients have some knowledge of what is involved in the preparation of an advance directive and that they feel these documents are important. A relatively small percentage have completed their own written directives but a large percentage planned to do so after completing this survey. There is some disagreement about when after the injury the topic should first be discussed. Information about medical conditions which are more likely to arise following a SCI should be included in an SCI-specific document. A template for an SCI-specific living will (the SCIAD) is provided.