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Abstract
Advance directives (AD) document treatment decisions of a person when he or she still possesses mental capacity, in preparation for loss of such capacity due to disease. AD is commonly used in patients with advanced cancer. Objectives: To identify common factors influencing AD completion in Chinese cancer patients, and to examine the implementation of completed ADs in our unit. Methods: This retrospective analysis included patients with advanced cancer without active oncological treatment, recruited in a local palliative care unit between October 6th 2014 and September 30th 2015. Data collected included demographic characteristics, pain control, risk assessment for suicidality and complicated caregiver bereavement, and score in Hospital Anxiety and Depression Scale. Univariate analyses evaluating factors associated with AD completion and noncompletion were conducted. Results: 47 patients were deemed eligible for analysis, 25 (53.2%) of whom completed an AD. All ADs were carried out as per patients' preferences. Though no statistically significant predictive factors were identified, age, family influence and patients' knowledge on ADs were found to potentially influence patients' decisions regarding AD completion. Conclusion: A high rate of AD completion in our study suggests that discussion of AD in Chinese patients with advanced cancer is feasible, and education and family engagement in careplanning may increase AD completion.
Keywords: Advance directives, advance care planning, cancer, Chinese
Introduction
Cancer is a major global health burden. In Hong Kong, the number of new cancer cases has risen at an average annual rate of 2.5% between 2002 and 2012 (1). For patients with incurable cancer, the chance of losing adequate mental capacity to make independent health-related decision is expected to increase with time. In a study of patients with terminal diseases, 70% were reported to have lost mental capacity by the time decision-making was required (2).
The use of advance directives (AD) allows one to make treatment decisions before the loss of such capacity (3). Besides allowing patient to exercise autonomy, AD helps to relieve stress and anxiety of both families and health care professionals (2, 4-8).
Legislations for AD are well-developed in many countries. Hong Kong is still in its infancy in this regard. In 2004, the Hong Kong Law Reform Commission issued the first public consultation paper "Substitute decision-making and advance directives in relation to medical...