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Cited by 54Palliative Care and End-of-Life IssuesEthics and bioethics in healthcareDialysis and Renal Disease Management

The DOI matches its Crossref record; 13 of the 13 references it cites were found in a registry or an index.

Factors influencing dialysis patients' completion of advance directives

Open access
Holley, Jean L., Stackiewicz, Lucy, Dacko, Carol, Rault, Raymond·1997·American Journal of Kidney Diseases
DOI 10.1016/s0272-6386(97)90279-1
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Abstract

Although chronic dialysis patients support the use of advance directives, they rarely complete them. We asked 80 chronic dialysis patients (60 receiving in-center hemodialysis and 20 receiving peritoneal dialysis) why they had not completed an advance directive, and gave them the opportunity to complete a dialysis-specific living will and to designate a health care proxy. Questionnaires containing the dialysis-specific living will, patient demographic information, and questions about advance directives were distributed during a routine hemodialysis session or peritoneal dialysis clinic visit by a nurse working in the unit. Forty-one hemodialysis patients and 14 peritoneal dialysis patients completed the questionnaires (69% response rate). The mean age was 53 +/- 15 years and the mean time on dialysis was 5 +/- 5 years. Fifty-eight percent of the patients were women, 57% were white, 67% were hospitalized in the past year, 23% were employed, 70% had children, and 21% lived alone (43% lived with a partner and 11% lived with parents). All patients thought advance directives were a good idea, but only 35% had completed one and only seven (14%) had discussed wishes for life-sustaining therapy with their nephrologist; 34 patients (67%) had discussed their wishes with their family. Most said they had not completed an advance directive because their family knew what they would want (12 of 32 patients [38%]). Thirty-nine patients who completed the questionnaire also completed the dialysis-specific living will (71%). Those who did not complete the dialysis-specific living will chose not to because they were not sure what they would want done (12 of 16 patients [75%]). The only demographic factor that influenced completion of the dialysis-specific living will was having children: more patients with children did not complete the will (12 of 37 patients [32%] with children v two of 16 patients [13%] without children; P = 0.02). The dialysis-specific living will asks about choices for life-sustaining treatment (cardiopulmonary resuscitation and dialysis) based on one's health state (current health; permanent coma; terminal illness; mild, moderate, or severe stroke; dementia). Using patient-specific advance directives that focus on health states rather than life-sustaining interventions (eg, the dialysis-specific living will) and repeated discussion of advance directives and advance care planning initiated by dialysis unit staff may improve the completion of advance directives by chronic dialysis patients. The appropriate focus of such issues should include family involvement and health states rather than treatment interventions.

Overview

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Crossref · 10.1016/s0272-6386(97)90279-1

Cites

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Citations

Cites

Show all 13 references

Research works printed but not linked: 2

  1. Moss, 1996, Elderly dialysis patient preferences for advance care planning, J Am Soc Nephrol, 7, 1458
  2. Moss, 1991, Dialysis unit practices and policies about life-sustaining treatments, Am J Kidney Dis, 17, A17

Cited by

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Metadata

Authors
Holley, J. L., Stackiewicz, L., Dacko, C., & Rault, R.
Affiliations
University of Pittsburgh Medical Center (US)
Corresponding author
Holley, Jean L.
ORCID
Holley, Jean L.
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
1997-09
Volume
30
Issue
3
Pages
356-360
ISSN
0272-6386 (ISSN-L)
DOI
10.1016/s0272-6386(97)90279-1
OpenAlex
W1985736318
Cited by
54
References
13
Citations by year
2026: 1 · 2021: 1 · 2020: 2 · 2018: 4 · 2017: 2 · 2016: 7 · 2015: 3 · 2014: 2 · 2012: 1
FWCI
2.76
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
advance directives, living wills, dialysis patients, advance care planning, health care proxy, life-sustaining treatment, family decision-making, having children, hemodialysis, peritoneal dialysis, end-of-life care, patient education, nephrology nursing, cardiopulmonary resuscitation
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Renal Dialysis, Humans, Male, Middle Aged, Peritoneal Dialysis, Surveys and Questionnaires, Advance Directives, Living Wills

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