FACTORS INFLUENCING DIALYSIS PATIENTS COMPLETION OF ADVANCE DIRECTIVES

Although chronic dialysis patients support the use of advance directiv es, they rarely complete them. We asked 80 chronic dialysis patients ( 60 receiving in-center hemodialysis and 20 receiving peritoneal dialys is) why they had not completed an advance directive, and gave them the opportunity to complete a dialysis-specific living will and to design ate a health care proxy. Questionnaires containing the dialysis-specif ic living will, patient demographic information, and questions about a dvance directives were distributed during a routine hemodialysis sessi on or peritoneal dialysis clinic visit by a nurse working in the unit. Forty-one hemodialysis patients and 14 peritoneal dialysis patients c ompleted the questionnaires (69% response rate). The mean age was 53 /- 15 years and the mean time on dialysis was 5 +/- 5 years. Fifty-eig ht percent of the patients were women, 57% were white, 67% were hospit alized in the past year, 23% were employed, 70% had children, and 21% lived alone (43% lived with a partner and 11% lived with parents). All patients thought advance directives were a good idea, but only 35% ha d completed one and only seven (14%) had discussed wishes for life-sus taining therapy with their nephrologist; 34 patients (67%) had discuss ed their wishes with their family, Most said they had not completed an advance directive because their family knew what they would want (12 of 32 patients [38%]). Thirty-nine patients who completed the question naire also completed the dialysis-specific living will (71%). Those wh o did not complete the dialysis-specific living will chose not to beca use they were not sure what they would want done (12 of 16 patients [7 5%]). The only demographic factor that influenced completion of the di alysis-specific living will was having children: more patients with ch ildren did not complete the will (12 of 37 patients [32%] with childre n v two of 16 patients [13%] without children; P = 0.02). The dialysis -specific living will asks about choices for life-sustaining treatment (cardiopulmonary resuscitation and dialysis) based on one's health st ate (current health; permanent coma; terminal illness; mild, moderate, or severe stroke; dementia), Using patient-specific advance directive s that focus on health states rather than life-sustaining intervention s leg, the dialysis-specific living will) and repeated discussion of a dvance directives and advance care planning initiated by dialysis unit staff may improve the completion of advance directives by chronic dia lysis patients, The appropriate focus of such issues should include fa mily involvement and health states rather than treatment interventions , (C) 1997 by the National Kidney Foundation, Inc.