INTRODUCTION

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in the Philippines. Most Filipino CKD patients prefer hemodialysis due to barriers such as cost and availability of Kidney Transplant. End-stage kidney disease (ESKD) patients face high symptom burden and unmet palliative care needs. Even with advancement in dialysis technology, the annual mortality rate of dialysis patients remains between 20% and 25%. While Advance Care Planning (ACP) can help align care with patient preferences by facilitating discussions about values and future decisions, its utilization in dialysis population remains low due to barriers in implementation. There is limited research specifically addressing the preferences and influencing factors of Advance Care Planning among CKD patients on hemodialysis in the Philippines.

This study aimed to determine the ACP preferences of CKD patients undergoing hemodialysis and to identify the clinicodemographic factors associated with these preferences.

An analytic cross-sectional study was conducted involving 96 chronic kidney disease (CKD) patients undergoing hemodialysis at Baguio General Hospital and Medical Center (BGHMC) from October to November 2024. Data were collected using validated questionnaires administered either through face-to-face interviews or self-administration, depending on patients’ preferences and capabilities. Descriptive and inferential statistical methods were employed for data analysis.

The study revealed limited awareness of ACP among participants (86.5%), underscoring the need for education. Family-centered decision-making was prominent, with most participants preferring family members as surrogate decision-makers and confidants. Quality of life was prioritized over life extension, and preferences for “Do Not Resuscitate” (DNR) orders were notable. Educational attainment and ethnicity significantly influenced preferences, with higher education linked to greater awareness; and Ethnicity shaping preferences for decision-makers, confidants, timing of discussions, and resuscitation choices. Additionally, duration of dialysis was linked to care setting preferences, while social support systems influenced the preferred place for discussions.

The findings highlight critical associations between clinicodemographic factors and ACP preferences among hemodialysis patients. Addressing these associations through targeted education and culturally sensitive approach can promote high-quality end-of-life care, aligned with diverse patient needs, values, and preferences.

BACKGROUND

Advance care planning (ACP) discussions are vital, but they remain largely neglected and met with resistance in the Philippines. The general population, especially non-medical individuals, has not actively engaged in ACP. To address this, we developed the ‘ACP-READY’ program for primary care settings.

This study aimed to assess the effectiveness of ‘ACP-READY’ in facilitating the completion of Advance Directives (ADs) among non-medical personnel and identifying barriers to their completion.

A randomized, controlled, single-blind approach with a quantitative survey followed by qualitative semi-structured interviews enrolled 161 English-literate, legally competent individuals aged 18-65 from a hospital’s non-medical staff. Participants were randomly assigned to control (n=77) or intervention (n=84) groups. We initially evaluated participants’ readiness for ACP (ACPRe)1. Subsequently, both groups were instructed to complete an AD form in their preferred language, with the experimental group receiving an interactive ACP seminar. Post-test assessments gauged participants’ willingness to complete their AD. A focused-group discussion was conducted to explore their experiences.

Baseline characteristics were similar between groups. There was no statistical difference in readiness improvement and AD completion rates between the control and intervention groups. Well-worded brief instruction and comprehensive seminars were equally effective in enhancing readiness and promoting AD completion (pCONCLUSION

Concise and well-presented instruction on ACP is as effective as comprehensive seminars in promoting AD completion among medically stable individuals. Family physicians, with their longitudinal, patient-centered approach, can address some of the identified barriers.

Objectives: To explore the current experiences and perspectives of patients with chronic obstructive pulmonary disease (COPD) with advance care planning (ACP). Methods: A cross-sectional survey was conducted among patients diagnosed with COPD in the Philippine General Hospital. Results were illustrated using descriptive statistics. Results: A total of 90 patients were interviewed and included in the analysis. Nearly all patients were unfamiliar with the terms ACP (95.55%), end-of-life care (99.89%), and do-not-resuscitate order (100%). The majority expressed a desire to have ACP discussions (94.44%) which were not viewed as distressing and were deemed beneficial (96.67%). Patients who were employed were more likely to express readiness to sign legal papers. Patients living with their nuclear family or living alone, and those with higher COPD assessment test (CAT) scores were more likely to relegate health care decisions to their doctors. Conclusion Most patients with COPD in our cohort are unfamiliar with ACP and have not received ACP discussions. Most think that it will improve healthcare and quality of life. Some demographic and clinical factors may make patients more likely to engage in ACP-related activities.
advance care planning ; chronic obstructive pulmonary disease ; palliative medicine

PURPOSE: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. METHODS: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. RESULTS: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=−3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=−2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=−3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. CONCLUSION: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.
Advance Care Planning ; Advance Directives ; Aged ; Health Care Costs ; Humans ; Long-Term Care ; Nursing Homes ; Terminal Care

PURPOSE: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward.METHODS: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital.RESULTS: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MK-POLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation.CONCLUSION: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients.
Advance Care Planning ; Advance Directives ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Child ; Cohort Studies ; Hospice Care ; Hospices ; Humans ; Medical Records ; Palliative Care ; Parenteral Nutrition ; Retrospective Studies ; Spouses ; Terminal Care ; United States ; Ventilators, Mechanical

BACKGROUND: This study investigated the current status of communication about death and confidence levels concerning death-related issues among Korean adults.METHODS: A survey was conducted to ascertain the frequency of death related communication, factors promoting and impeding such communication, and confidence levels concerning death-related issues. Data of 112 participants who completed the survey were analyzed using descriptive statistics, a chi square test, and multiple logistic regression.RESULTS: More than half of the participants (52.7%–84.0%) appeared to have infrequent (never/at least one) conversations about death or death-related issues. Owing to socio-cultural aspects, death-related communication was considered a taboo or an unpleasant topic of conversation. Additionally, indifference toward death inhibited people from communicating; however, personal experiences of death or morbidity and favorable social contexts promoted communication. Overall, the confidence levels concerning death-related issues was low. Only 17.9%–32.2% of the participants were confident/very confident about their preferences concerning death-related issues. The more people talked about death, the more likely they were to develop a confident attitude toward death-related issues (odds ratio, 3.45; 95% confidence interval, 1.37–8.69).CONCLUSION: This study confirmed that communication about death is being withheld among Koreans, and this could possibly lower their level of confidence regarding death-related issues. To achieve death with dignity, a ‘death culture’ needs to be promoted alongside legislation and infrastructure.
Adult ; Advance Care Planning ; Attitude to Death ; Humans ; Logistic Models ; Personal Autonomy ; Right to Die ; Taboo ; Terminal Care

OBJECTIVE: Multiple System Atrophy (MSA) and progressive supranuclear palsy (PSP) are rapidly progressive forms of degenerative Parkinsonism. The difficulties of diagnosing MSA and PSP in their early stages may lead to delayed referral to appropriate specialists and distress to patients, as well as delaying symptomatic treatment and participation in clinical trials. This work aimed to describe the symptoms that patients with MSA and PSP developed and plot their emergence relative to final diagnosis using a median onset in months. METHODS: Forty-seven patients from the United Kingdom with MSA or PSP diagnosed by a movement disorder specialist were interviewed with carers or relatives to establish milestone onset. This was corroborated using clinical notes and letters. RESULTS: In the MSA cohort (n = 23), autonomic symptoms (median 5.5 months before diagnosis) and falls (median 1 month before diagnosis) were the two clinical milestones which occurred before diagnosis. In the PSP cohort (n = 24), falling was the only milestone which occurred before diagnosis (median of 18.5 months). CONCLUSION: This study shows that PSP patients experience falling more than a year and a half an average before receiving a diagnosis and although MSA patients also tended to fall, this was much closer to the time of diagnosis. Further work with larger cohorts may illustrate whether these preliminary findings can be generalised to guide diagnosis and management.
Accidental Falls ; Advance Care Planning ; Caregivers ; Cohort Studies ; Delayed Diagnosis ; Diagnosis ; Great Britain ; Humans ; Movement Disorders ; Multiple System Atrophy ; Parkinsonian Disorders ; Referral and Consultation ; Retrospective Studies ; Specialization ; Supranuclear Palsy, Progressive

Advance Care Planning ; ethics ; legislation & jurisprudence ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Decision Making ; ethics ; Female ; Humans ; Male ; Middle Aged ; Patient Preference ; statistics & numerical data ; Risk Assessment ; Singapore ; Terminal Care ; ethics ; methods ; Third-Party Consent ; ethics ; legislation & jurisprudence

PURPOSE: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. METHODS: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. RESULTS: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P < 0.05). CONCLUSION: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.
Advance Care Planning ; Cause of Death ; Central Nervous System ; Critical Care ; Decision Making ; Humans ; Medical Records ; Resuscitation Orders* ; Retrospective Studies ; Terminal Care ; Ventilators, Mechanical

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.
Advance Care Planning ; Caregivers ; Consensus ; Hospices ; Humans ; Judgment ; Jurisprudence ; Korea ; Palliative Care ; Patient Care ; Specialization