Usefulness of questionnaires on advance directives in haemodialysis units.

Autor:	Jornet AR; Nephrology and Computer Services, Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain and Sanitary Corporation., Castellanos LAB; Nephrology and Computer Services, Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain and Sanitary Corporation., Contador MIB; Nephrology and Computer Services, Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain and Sanitary Corporation., Morera JCO; Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain., López JAI; Nephrology and Computer Services, Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain and Sanitary Corporation.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2017 Oct 01; Vol. 32 (10), pp. 1676-1682.
DOI:	10.1093/ndt/gfx245
Abstrakt:	Background: As renal replacement therapy has become universal practice in medicine, there is a need to consider whether this treatment is suitable for elderly people. These patients have high comorbidity and may require dialysis withdrawal in certain clinical circumstances. Advance directives (ADs) drawn up by patients facilitate treatment-related decisions if they lose cognitive capacity. Questionnaires dealing with possible extreme clinical circumstances can thus help clinicians and relatives reach pertinent decisions in such cases. Methods: We studied the usefulness of questionnaires on ADs in patients who started periodic haemodialysis over a period of 10 years. Telephone interviews were conducted to assess satisfaction level among relatives/representatives of deceased patients who had been advised to limit therapeutic efforts in certain clinical situations. The questionnaire was assessed using a six-factor degree of satisfaction. Results: Four hundred and forty-three questionnaires were distributed over a period of 10 years. A total of 41.3% of patients stated that they wished to limit therapeutic efforts in the serious clinical situations presented; 37.9% refused to complete the questionnaire; 14.7% expressed their wishes without any written confirmation; and 6.1% expressed their wish to continue on dialysis in all situations. Two hundred and twenty-four patients had died by the study end date. The cause of death in 20.2% was scheduled dialysis withdrawal. Representatives reported an extremely high degree of satisfaction with the questionnaire (94.7%). Younger people, however, were more reluctant to consider and answer questionnaires on ADs. Conclusions: Questionnaires on ADs are a useful tool in daily nephrology practice and should be distributed to those patients willing to consider the limitation of therapeutic efforts in extreme clinical circumstances. In general terms, these questionnaires should be given to all elderly patients. (© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
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