END-OF-LIFE DECISIONS AND ADVANCE DIRECTIVES IN PALLIATIVE CARE - A CROSS-CULTURAL SURVEY OF PATIENTS AND HEALTH-CARE PROFESSIONALS

In order to explore possible differences in the scope of end-of-life d ecisions and attitudes toward advance directives (AD) in palliative ca re, we conducted a survey of 159 patients in palliative care instituti ons and 93 health-care professionals experienced in palliative care in the United States, Germany, and Japan. Giving an AD in this clinical setting was considered important by patients and professionals. The pr evalence of a formal written Ao was 79% in the United States, 18% in G ermany, and 9% in Japan. In Japan, there was a high prevalence of entr usting all decisions to the family (known as omakase). More than 80% o f the patients had negative feelings toward their future decisions in the United States and Germany, in contrast to only 45% in Japan. Altho ugh favored by the professionals, there were no specific instruments f or obtaining ADs. In Germany and Japan, some patients had given an inf ormal AD. As a pilot content validity step, survey results were used t o derive a checklist for content and procedural aspects in end-of-life decision-making. This checklist may provide the basis for developing an instrument to guide physicians, especially non-palliative care spec ialists, in communication with their patients and their families in th is difficult clinical situation. (C) U.S. Cancer Pain Relief Committee , 1998.