Role of Uncertainty in Illness and Coping Strategies in Advance Directive Completion in Patients With End-stage Liver Disease

Olivia Fuson; Arnab Mitra; Carley Little; Shirin Hiatt; Heather Franklin; Nathan F Dieckmann; Lissi Hansen

doi:10.1097/MCG.0000000000001981

Role of Uncertainty in Illness and Coping Strategies in Advance Directive Completion in Patients With End-stage Liver Disease

J Clin Gastroenterol. 2024 Apr 1. doi: 10.1097/MCG.0000000000001981. Online ahead of print.

Authors

Olivia Fuson¹, Arnab Mitra², Carley Little³, Shirin Hiatt⁴, Heather Franklin⁴, Nathan F Dieckmann⁴, Lissi Hansen⁴

Affiliations

¹ Department of Medicine, Oregon Health & Science University, Portland OR 97239, USA.
² Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health & Science University, Portland OR 97239, USA.
³ Internal Medicine.
⁴ School of Nursing, Oregon Health & Science University, Portland OR 97239, USA.

PMID: 38567890
DOI: 10.1097/MCG.0000000000001981

Abstract

Objective: We examined the associations among advance directives (ADs) completion, coping, uncertainty in illness, and optimism and pessimism in patients with end-stage liver disease (ESLD).

Background: Although associations among ADs, coping, and uncertainty have been studied in patients with other life-limiting illnesses, these concepts have not been studied together in patients with ESLD.

Patients and methods: Patients were recruited at 2 health care institutions as part of a larger prospective study. They were enrolled if they had a diagnosis of nonhepatocellular carcinoma ESLD, Sodium Model for End-Stage Liver Disease ≥15, and no prior history of liver transplantation. Uncertainty, coping, optimism, and pessimism were assessed using the Uncertainty in Illness Scale for Adults, Revised Ways of Coping Checklist, and Life Orientation Test-revised. AD documentation at the time of study enrollment was retrospectively extracted from patient medical records.

Results: In the sample [N = 181; median age = 57 y, 115 (64%) males], male sex [odds ratio (OR) = 4.66; 95% CI: 1.53, 14.17], being listed or under evaluation for liver transplantation (OR = 3.09; 95% CI: 1.10, 8.67), greater Sodium Model for End-Stage Liver Disease scores (OR = 1.10; 95% CI: 1.01, 1.20), and greater uncertainty (OR = 1.04; 95% CI: 1.01, 1.07) were positively associated with AD documentation. Higher coping avoidance was negatively associated with AD documentation (OR = 0.915; 95% CI: 0.840, 0.997).

Conclusions: Clinicians should consider the role of uncertainty and coping measures to improve patient-specific advance care planning conversations and expand opportunities for all patients with ESLD to file an AD, especially women and patients not listed or under evaluation for transplantation.