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The effects of providing chronic hemodialysis patients written material on advance directives
J L Holley1, S Nespor, R Rault
1Renal-Electrolyte Division, University of Pittsburgh, PA.
Insights
Written information on advance directives improved completion rates in hemodialysis patients but did not significantly enhance understanding of living wills or healthcare proxies long-term.
Area of Science:
- Nephrology
- Bioethics
- Health Communication
Background:
- Limited understanding exists regarding the stability of knowledge, attitudes, and behaviors concerning advance directives (ADs) among chronic hemodialysis patients.
- Chronic hemodialysis patients face unique challenges that may impact their engagement with end-of-life care planning.
Purpose of the Study:
- To evaluate the impact of written information on advance directives on the knowledge, attitudes, and behavior of chronic hemodialysis patients over time.
- To assess the association between patient demographic factors and these parameters.
Main Methods:
- A cohort of 31 chronic in-center hemodialysis patients completed a questionnaire assessing knowledge, attitudes, and behavior toward ADs at three time points: before, shortly after, and 6-7 months after receiving written information.
- Patient demographics were also collected.
Main Results:
- Written information did not lead to sustained improvements in understanding of living wills, healthcare proxies, or hospital policies on ADs.
- While attitudes towards ADs remained unchanged, the completion rate of ADs by patients and their family members significantly increased shortly after receiving information, with a slight decrease at the later time point.
- Demographic factors were assessed for association, though specific findings are truncated in the abstract.
Conclusions:
- Providing written information on advance directives can transiently improve knowledge and significantly increase the completion of ADs among chronic hemodialysis patients.
- Long-term understanding and consistent engagement with ADs may require more comprehensive interventions beyond written materials for this population.
Abstract:
Because little is known about the stability of knowledge, attitudes, and behavior toward advance directives in chronic hemodialysis patients, we chose to determine whether providing written information on advance directives affects chronic hemodialysis patients' knowledge, attitudes, and behavior toward advance directives over time. Various patient demographic factors were also assessed for association with the above parameters. Thirty-one chronic in-center hemodialysis patients (55% women, 48% African-Americans, 81% on dialysis for more than 3 years) completed a questionnaire consisting of patient demographic features and agreement or disagreement with statements concerning knowledge, attitudes, and behavior toward advance directives. The responses were scored from 1 (strongly agree) to 5 (strongly disagree). Patients completed the questionnaire before, shortly after (1 to 3 months), and distant to (6 to 7 months) receiving written information on advance directives. Receiving written information on advance directives did not improve patients' understanding of living wills (58% understood before, 77% shortly after, and 58% distant to receiving the information) and only transiently improved understanding of a health care proxy (32% before, 67% shortly after [P < 0.006], 55% distant [P = not significant]) and the hospital policy on advance directives (35% before, 61% shortly after [P < 0.02], 48% distant [P = not significant]). Patients' attitudes about advance directives and perceived barriers to their use were not different before, shortly after, or distant to receiving information. After receiving information on advance directives, more patients (13% before, 48% shortly after, 37% distant; P < 0.002) and their family members (10% before, 30% shortly after, 20% distant; P < 0.02) completed advance directives.(ABSTRACT TRUNCATED AT 250 WORDS)