Advance directives among community-dwelling stroke survivors

Advance directives (ADs) are integral to health care, allowing patients to specify surrogate decision-makers and treatment preferences in case of loss of capacity. The present study sought to identify determinants of ADs among stroke survivors. In this cross-sectional study (Care Attitudes and Prefe...

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Vydáno v:PloS one Ročník 18; číslo 10; s. e0292484
Hlavní autoři: Gupta, Soumya, Chen, Bridget J., Suolang, Deji, Cooper, Rachel, Faigle, Roland
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Public Library of Science 17.10.2023
Public Library of Science (PLoS)
Témata:
Advance Directives
Advertising executives
Age
Aged
Attitudes
Biology and Life Sciences
Care and treatment
Computer and Information Sciences
Cross-Sectional Studies
Demographics
Diseases
Education
Female
Humans
Independent Living
Knowledge
Male
Males
Medical colleges
Medical law
Medicine and Health Sciences
Palliation
Palliative care
Palliative treatment
Patient outcomes
Patients
People and Places
Physicians
Regression analysis
Relapse
Research and Analysis Methods
Social Sciences
Stroke
Stroke (Disease)
Stroke - therapy
Stroke patients
Surveys
Survival
Survivor
Survivors
United States
United States > US
Maryland
ISSN:1932-6203, 1932-6203
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Shrnutí:Advance directives (ADs) are integral to health care, allowing patients to specify surrogate decision-makers and treatment preferences in case of loss of capacity. The present study sought to identify determinants of ADs among stroke survivors. In this cross-sectional study (Care Attitudes and Preferences in Stroke Survivors [CAPriSS]), community-dwelling stroke survivors were surveyed on ADs; validated scales were used to query palliative care knowledge and attitudes towards life-sustaining treatments. Logistic regression was used to determine variables associated with ADs. Among 562 community-dwelling stroke survivors who entered the survey after screening questions confirmed eligibility, 421 (74.9%) completed survey components with relevant variables of interest. The median age was 69 years (IQR 58-75 years); 53.7% were male; and 15.0% were Black. Two hundred and fifty-one (59.6%) respondents had ADs. Compared to stroke survivors without ADs, those with ADs were more likely to be older (median age 72 vs. 61 years; p<0.001), White (91.2% vs. 75.9%, p<0.001), and male (58.6% vs. 46.5%, p = 0.015), and reported higher education (p<0.001) and income (p = 0.011). Ninety-eight (23.3%) participants had "never heard of palliative care". Compared to participants without ADs, participants with ADs had higher Palliative Care Knowledge Scale (PaCKS) scores (median 10 [IQR 5-12] vs. 7 [IQR 0-11], p<0.001), and lower scores on the Attitudes Towards Life-Sustaining Treatments Scale (indicating a more negative attitude towards life-sustaining treatments; median 23 [IQR 18-28] vs. 29 [IQR 24-35], p<0.001). Multivariable logistic regression identified age (OR 1.62 per 10 year increase, 95% CI 1.30-2.02; p<0.001), prior advance care planning discussion with a physician (OR 1.73, 95% CI 1.04-2.86; p = 0.034), PaCKS scores (OR 1.06 per 1 point increase, 95% CI 1.01-1.12; p = 0.018), and Attitudes Towards Life-Sustaining Treatments Scale scores (OR 0.91 per 1 point increase, 95% CI 0.88-0.95; p<0.001) as variables independently associated with ADs. Age, prior advance care planning discussion with a physician, palliative care knowledge, and attitudes towards life-sustaining treatments were independently associated with ADs.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0292484