Temporal trend in understanding of and attitudes to advance directives in patients with chronic diseases

Objective: To describe patients' degree of knowledge about their diseases and advance directives, as well as their willingness to write these documents, among patients with chronic diseases seen in the emergency department. Methods: We performed a prospective, comparative, cross-sectional study, without intervention and with consecutive patient inclusion in two periods (2003 and 2008). Demographic and clinical data were recorded. An anonymous interview about patients' knowledge and opinions about their illness and their awareness of advance directives was performed. Previous awareness of advance directives and the predisposition to write these documents were taken as dependent variables, and factors associated with these variables were analyzed. Results: In both periods, 381 patients with similar characteristics were included (191 in 2003 and 190 in 2008). Patients showed greater knowledge of their disease (74% vs 55%, p < 0,001), a greater predisposition to take part in medical decisions (62% vs 42%, p < 0,001). and higher participation in such decisions (48% vs 35%, p = 0.01) in 2008 than in 2003. However, awareness of advance directives was slightly lower (18% vs 23%, p = NS), and willingness to write these documents was unchanged (50% vs 50%, p = NS). Awareness of advance directives was associated with age less than 75 years and having completed secondary school. The predisposition to write advance directives was associated with previous awareness of these documents, considering oneself to be well informed, and wanting greater participation in medical decisions. Conclusions: Patients with chronic diseases showed greater understanding of their disease in the second period but awareness of advance directives and willingness to write these documents remained low. Information on these issues should be improved as an essential part of the physician-patient relationship. (C) 2010 SESPAS. Published by Elsevier Espana, S.L. All rights reserved.