Attitudes of patients with malignancies towards completion of advance directives

Support Care Cancer. 2010 Mar;18(3):367-72. doi: 10.1007/s00520-009-0667-6. Epub 2009 May 31.


Aim: The purpose of advance directives (AD) is to preserve the patient's autonomy at the end of his/her life. In a cohort study, we investigated attitudes towards AD in hospitalized patients with malignant disease.

Materials and methods: All patients were informed about the basic features of AD in a standardized manner by a single independent physician. One hundred and eight (39 women, 69 men; mean age 56.6 +/- 14.9 years) of 140 invited patients completed the study.

Main results: Five percent of patients (5/108) already had an AD; 85% (92/108) did not wish to issue an AD. "Full confidence in physicians" (22%) and "not important for me at the moment" (15%) were the most frequently stated reasons for not issuing an AD. Only 10% (11/108) of patients decided to complete an AD. Their decision was not related to a specific diagnosis or a number of socio-demographic variables that were studied. Patients who decided in favor of an AD had significantly higher Hospital Anxiety and Depression Scale (HADS-D) score than those who decided against it (HADS-D, 8.3 +/- 5.0 vs.5.8 +/- 4.1, p = 0.035). The patients' HADS depression score was negatively associated with their Karnofsky index (r = -0.232, p = 0.017).

Conclusions: Our data reveal a scarce demand for AD in our population of hospitalized cancer patients. Patients who wanted to issue an AD had a high HADS-D, which is associated with a low performance status.

MeSH terms

  • Adult
  • Advance Directive Adherence / statistics & numerical data*
  • Advance Directives / psychology*
  • Advance Directives / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Austria
  • Cohort Studies
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Neoplasms / psychology*
  • Population Surveillance
  • Young Adult