Survey on German Palliative Care Specialists' Experiences with Advance Directives

Abstract

Introduction: Advance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals' views on advance directives (AD).

Methods: A questionnaire was handed out to attendants of a palliative care symposium.

Results: Complete answers were obtained from 126 physicians and 276 nurses. Almost all physicians and nurses had treated patients with an AD, and the majority more than 10 patients. The most frequent refusal by the patients was resuscitation (87.8%) followed by intensive care (79.1%), artificial ventilation, and nutrition. The most frequent wish was pain therapy (92.3%) followed by allowing the natural course of the illness (64.4%). The wish for hospice treatment (44.8%) or spiritual care (39.3%) was less frequent.

Discussion: The results hint at fears and deficits in the care of patients at the end of life. Often the quality of life and not the quantity of days remaining is in the center of a patient's will and points to the growing importance of palliative care.

Conclusion: ADs are well established among palliative care professionals and regarded as helpful for patients at the end of life.

Keywords: Advance directive; End of life; Nurses; Palliative care; Physicians; Questionnaire; Terminal care.