INTRODUCTION: Advance directives are documents by which a person makes provisions for health care decisions in the event that, in the future, that person becomes unable to make those decisions. There is a lack of studies on the knowledge and understanding towards advance directives among patients and their families. The purpose of this study is to address this lack of research regarding advance directives by measuring the level of knowledge and attitudes of families of hospitalized patients. METHODS: A descriptive, cross-sectional study design was used to describe the attitudes and the level of knowledge on advance directives of the families of patients. Data were collected directly by the researchers via assisted questionnaires. Descriptive statistics and frequencies were reported. RESULTS: A total of 79 participants consisting of immediate family members of patients from UERMMMCI were enrolled. Only 24% reported having discussed advance directives with the patient's physician. Those respondents whose families had no discussion with their physician about advance directives had the same score as those who had. Overall, 61% of participants have only medium to low knowledge of advance directives, while 70% have positive attitudes regarding advance directives. CONCLUSION The study showed that the family members of patients had a reasonable understanding of advance directives in terms of basic knowledge, and positive attitudes on advance directives. Those who denied having discussed advance directives were comparable in the knowledge of advance directives with those who did.

Background : Quality of life (QoL) is arguably as important as the survival rate in patients with hepatocellular carcinoma (HCC). However, very few studies have evaluated the factors that determine good or poor QoL in patients with HCC.Objectives:To correlate baseline QoL (EORTC-QLQC30) with baseline laboratory and clinical parameters among HCC patients.Patients and Method: Thirty nine consecutive newly-diagnosed HCC patients were recruited, Spearman;s rank correlation was used to correlate the QoL scores, which consisted of 15 domians, wirg continous baseline variables while the Mann-Whitney U or kruskal Wallis tests were used for categorial variables.Results: The mean age of the cohort was 61.3 +- 14.5, majority of whom were male(89.7). Majority had childs Pugh Turcott (CPT) score af A (61.5%) and barcelona Clinic Liver cancer (BCLC) stage A-B (76.9%). A third (33.3%) knew of their diagnosis at the time of QoL between the 2 groups (p>0.05). There was no consistent pattern in the correlation between laboratory parameters with QoL, with some running contrary to conventional reasoning (Higher international normalized ratio correlation with better role function[p=0.02] and less pain [0.035]; CPT score A associated with lower global health status compared to CPT B/C [p=0.028]). On the other hand, BCLC staging was a more sensible relection of QoL with BCLC A/B patients having higher physical (p=0.014) and social (p=0.049) function, and lower symptom scores for nausses/vomiting (p=0.041) and dyspnea (p=0.004) than patients with BCLC C/D.Conclusion: baseline EORTC-QLC-C30 of patients with HCC has no consistent correlation with the severity of liver dysfunction. Correlation of some domains of the EORTC-QLQ-C30 with BCLC staging suggests that umor burden is the main determinant of QoL in HCC patients. Further studies are needed to determine whether baseline QoL predicts survival independent of HCC staging.
Hepatocellular Carcinoma