Attitudes and Intentions of Adult Patients With Cancer Toward Advance Directive: Direct and Indirect Relationships

Abstract

Background: Advance directives (ADs) are used to respect the will of patients experiencing a terminal illness regarding preferred medical treatment and to protect their rights. However, the AD completion rate is low.

Objective: The aim of this study was to explore the factors influencing patient intentions toward AD.

Methods: The Theory of Planned Behavior was used as the framework for this study. This study used a cross-sectional design using a face-to-face interview with structured questionnaires. A total of 230 patients with cancer were recruited. Path analysis was used to examine the hypotheses.

Results: Demographic variables were not correlated with patients' attitudes toward AD. Patients' knowledge of AD ( β = .68, t = 16.15, P < .00) and recognition of important others' attitudes toward AD ( β = .30, t = 10.74, P < .00) were predictors of patients' attitudes toward AD. Patients' attitudes toward AD ( β = .27, t = 3.74, P < .00) and behavior control over AD ( β = .09, t = 1.99, P < .04) predicted patients' intentions toward AD.

Conclusion: Patients' knowledge of AD, the patients' important others' attitudes, and behavior control toward AD are predictively associated with the intention toward AD completion.

Implications for practice: Only when patients with cancer are provided an accessible approach for obtaining knowledge regarding AD and are given sufficient time and space can they and their significant others understand the meaning of AD and decide to complete one on their own terms.