Characteristics and use of advance directives in a tertiary hospital. Period 2001-2011

Objective: To evaluate the characeristics of patients who provide written advance directives and their use in healthcare practice. Methodology: Observational, descriptive, retrospective study of all written advance directives registered at a university hospital between 2001-2011. The clinical-demographic characteristics of the patients at the time they provided the documents was studied, as was as the later use of the documents through an electronic medical history analysis. Results: A total of 130 advance directive documents were registered. At the time of their provision, the average patient age was 61 years; some 64% were diagnosed with a neoplastic illness; 73% were completely independent (Barthel), and 36.4% presented no comorbidities (Charlson). The women were slightly older than the men (63 vs. 60, P = 0.17), and they were more likely to provide advance directives (61.5% vs. 31.5%, P = 0.01) than men; the womens' illnesses were less relevant (P = 0.001), and the women presented less comorbidity (P = 0.01). A total of 361 medical acts were reviewed (193 hospital admissions and 168 emergency visits). At the end of the study, 74 patients were alive (57%), 37 had died (28%), and in 19 cases (15%), their evolution was lost. Of those who died, 13 (35.1%) were functionally incapacitated in the terminal phase of their illness, and in 9 (69%), the advance directives were applied in the final phase of their illness. Conclusions: The number of registered advance directives is low; they do not interfere in the care process, and the documents are considered in the final decisions of life. (C) 2013 Elsevier Espana, S.L. All rights reserved.