Chronic in-center hemodialysis patients' attitudes, knowledge, and behavior towards advance directives

Forty-three chronic in-center hemodialysis patients were asked about their knowledge, attitudes, and behavior towards advance directives. The survey collected patient demographic data and assessed attitudes, knowledge, and behavior towards advance directives by agreement or disagreement with statements. Sixty-six percent of patients did not know what a health care proxy was, and 42% did not know the legal status of a living will. However, 90% of older patients (> or = 60 yr of age) understood living wills. Although 77% of the patients had discussed their wishes about life-sustaining care with someone close to them, only 17% had had such discussions with their doctor. Twenty-one percent had completed an advance directive. Fifty percent of patients agreed with the statement that a potential problem with advance directives was that patients could change their minds about heroic treatments; 51% agreed that advance directives might interfere with a doctor's judgment. Only 26% agreed that a dialysis unit's promotion of the use of advance directives might lead to undertreatment. Patient age, race, marital status, and time on dialysis did not affect responses. A prior failed transplant and the educational level completed by the patient influenced some specific responses. Despite some concern, 79% of patients agreed that a dialysis unit policy asking patients whether they had completed an advance directive was a good idea.