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: 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

PURPOSE: The purpose of this study was to identify nursing students’ knowledge and attitude toward advance directives and factors influencing the attitude. METHODS: A cross-sectional survey design was used and 196 nursing students participated in the study. Data were collected from July 1 to August 30, 2018 using a structured questionnaire which included biomedical ethics, awareness of good death, knowledge and attitude toward advance directives. Data were analyzed using SPSS/WIN 25.0 program with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. RESULTS: The mean score of biomedical ethics, awareness of good death, knowledge and attitude toward advance directives were 2.88±0.59, 3.18±0.48, 7.68±31.32, 31.00±3.09. Factors influencing the attitude toward advance directives were awareness of good death (β=.28, p<.001), intention of writing their advance directives (β=.19, p=.006), the knowledge related to advance directives (β=.15, p=.029). A total of 14% of attitude toward advance directives was explained by awareness of good death, the knowledge related to advance directives, and ntention of writing their advance directives. CONCLUSION: The findings of the study indicate that it is necessary to provide a systemic education program regarding advance directives for nursing students in order to provide knowledge related to advance directives and to help them establish positive attitudes toward advance directives.
Advance Directives ; Bioethics ; Cross-Sectional Studies ; Education ; Humans ; Intention ; Nursing ; Students, Nursing ; Writing

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 purpose of this study was to identify the relationships among nursing students' knowledge, attitudes to advance medical directives and ethics values. METHODS: The study was a cross-sectional and descriptive survey, carried out with 232 students from two schools of nursing, one located in B and C city. Student nurses' knowledge, attitudes for advance medical directives and ethics values were measured using structured self-report questionnaires. Data were analyzed using t-test or one-way ANOVA, and Pearson correlation coefficients. RESULTS: The scores for knowledge, attitudes for medical advance directives were 7.18 and 3.07, and for ethics values, 3.47. Nursing students' knowledge and attitude showed a significant difference depending on grade. Nursing students' ethics values showed significant differences depending on whether a study on ethics had been completed. A positive correlation was observed between nursing students' knowledge, attitudes for advance medical directives and ethics values. CONCLUSION: The results of this study indicate that basic data for the development of an effective education program on ethics is important in establishing a positive attitude toward advance medical directives and the appropriate ethical values in student nurses.
Advance Directives ; Education ; Ethics ; Humans ; Nursing ; Students, Nursing

The Supreme Court decision made on May 21, 2009 about the withdrawal of futile life-prolonging medical care from a persistently vegetative patient provided a legal basis for patients to consent to death with dignity, and also spurred a lively debate in Korea. The legal grounding of this decision was based on the principles of human dignity, worth, and the right to pursue happiness articulated in the Article 10 of the Constitution. The Death with Dignity Act was legislated to regulate decisions about life-prolonging medical care on February 3, 2016, after extensive debate and a focus on consensus that led to two revisions. However, the issue has not been completely resolved. First, the definition of the process of dying is unclear, because the points that determine whether a patient is dying are different from a simple assessment of whether an artificial ventilator should be attached or detached. Second, the purpose of this law is the protection of human dignity, worth, and the right to pursue happiness. However, nutrition, fluids, and oxygen must continue to be supplied, even after cessation of life-prolonging medical care. Is providing a continuous supply of nutrition, fluids, and oxygen a reasonable way to satisfy the goals of Article 10 of the Constitution? Third, if the withdrawal of life-prolonging medical care is possible based on the family's agreement without the patient's input, what is the legal value of advance directives? In conclusion, it may be necessary to partially revise the law regulating decisions on the withdrawal of life-prolonging medical care through further debate.
Advance Directives ; Consensus ; Constitution and Bylaws ; Happiness ; Humans ; Jurisprudence ; Korea ; Oxygen ; Persistent Vegetative State ; Personhood ; Right to Die ; Supreme Court Decisions ; Ventilators, Mechanical

PURPOSE: This methodological study was conducted to test the reliability and validity of an instrument that measures attitudes of advance directives (ADs) among nurses. METHODS: 1) Sixteen items related to attitudes in the English version of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) were forward/backward translated into Korean. 2) The content was validated by an expert panel (three nursing professors and eight hospice nursing specialists). 3) The preliminary 12 items were selected as a tool to assess the Korean version of Nurses' Attitudes towards Advance Directives (NAAD-K). 4) The instrument was validated by a survey (n=216). 5) It was confirmed to use the 12 items for the final version of the instrument. RESULTS: NAAD-K was shown to be valid in terms of factors, items and content. The three factors extracted from the factor analysis were named as follows: Caring for patients with an AD (factor 1), nurses' role in informing patients (factor 2) and patient right (factor 3). The three factors explained total variance 57.796%. Factor loadings of the 12 items ranged from 0.47 to 0.93. For the 12 items, Cronbach's alpha was 0.81, and Guttman split-half coefficient was 0.78. CONCLUSION: This instrument was identified to be applicable with satisfactory reliability and validity for further use in measuring nurses' attitudes towards ADs in hospice and palliative care.
Advance Directives ; Hospice and Palliative Care Nursing ; Hospices ; Humans ; Methods ; Nursing ; Palliative Care ; Patient Rights ; Reproducibility of Results