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dc.creatorSinger, Peter A.en
dc.creatorThiel, Elaine C.en
dc.creatorNaylor, C. Daviden
dc.creatorRichardson, Robert M.A.en
dc.creatorLlewellyn-Thomas, Hilaryen
dc.creatorGoldstein, Marcen
dc.creatorSaiphoo, Carlen
dc.creatorUldall, P. Roberten
dc.creatorKim, Donalden
dc.creatorMendelssohn, David C.en
dc.date.accessioned2015-05-05T18:59:02Zen
dc.date.available2015-05-05T18:59:02Zen
dc.date.created1995-11en
dc.date.issued1995-11en
dc.identifier.bibliographicCitationJournal of the American Society of Nephrology. 1995 Nov; 6(5): 1410-1417.en
dc.identifier.issn1046-6673en
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Life-Sustaining+Treatment+Preferences+of+Hemodialysis+Patients:+implications+for+Advance+Directives&title=Journal+of+the+American+Society+of+Nephrology.++&volume=6&issue=5&pages=1410-1417&date=1995&au=Singer,+Peter+A.en
dc.identifier.urihttp://hdl.handle.net/10822/750284en
dc.description.abstractThe purpose of this study was to describe the life-sustaining treatment preferences of dialysis patients and to compare the acceptability of two generic and a disease-specific advance directive (AD). Of 532 potentially eligible hemodialysis patients, 95 (17.9%) participated in the study. These patients completed two generic (the Centre for Bioethics Living Will and the Medical Directive) and one disease-specific (the Dialysis Living Will) AD in a randomized cross-over trial. Treatment preferences were measured by using the Centre for Bioethics Living Will. Acceptability of the AD was measured by using a 13-item advance directive acceptability questionnaire (ADAQ) for each AD, and the advance directive choice questionnaire (ADCQ) to elicit participants' preferred AD. Twenty-five percent of the participants wanted to continue dialysis in case of severe stroke, 19% in severe dementia, and 14% in permanent coma. Averaged across treatments, proportions of participants wanting treatment in various health states were: current health (86%), mild stroke (84%), moderate stroke (60%), severe stroke (21%), mild dementia (78%), moderate dementia (51%), severe dementia (14%), terminal illness (41%), and permanent coma (10%). Averaged across health states, proportions of participants wanting various types of treatment were: dialysis (58%), antibiotics (53%), transfusion (53%), surgery (48%), cardiopulmonary resuscitation (48%), respirator (47%), and tube feeding (41%). Mean ADAQ scores were: Dialysis Living Will, 71%; Centre for Bioethics Living Will, 70%; and Medical Directive, 60% (F = 8.27, P less than 0.001 (repeat measures analysis of variance); the Dialysis Living Will and Centre for Bioethics Living Will scored significantly higher than the Medical Directive). The proportion of participants who said they would choose to complete each AD was: Dialysis Living Will, 28%; Centre for Bioethics Living Will, 38%; Medical Directive, 31%; and unsure, 3% (chi 2 = 1.465, df = 2, P = 0.48). In conclusion, twenty-five percent or less of hemodialysis patients want to continue dialysis in three specific health states: severe stroke, severe dementia, and permanent coma. Health states and illness severity, far more than treatment descriptions, influence preferences. Dialysis patients should be offered a generic AD, and some generic AD are more acceptable than others. Only a minority of dialysis patients will complete any AD, but the completion of written AD forms is only one element in the process of advance care planning.en
dc.formatArticleen
dc.languageenen
dc.sourceBRL:MEDKIE/96159837en
dc.subjectAdvance Care Planningen
dc.subjectAdvance Directivesen
dc.subjectAllowing to Dieen
dc.subjectArtificial Feedingen
dc.subjectAttitudesen
dc.subjectBioethicsen
dc.subjectBlooden
dc.subjectBlood Transfusionsen
dc.subjectChronically Illen
dc.subjectComaen
dc.subjectDementiaen
dc.subjectDiseaseen
dc.subjectDrugsen
dc.subjectFormsen
dc.subjectHealthen
dc.subjectHemodialysisen
dc.subjectIllnessen
dc.subjectKnowledgeen
dc.subjectLifeen
dc.subjectLiving Willsen
dc.subjectMorbidityen
dc.subjectPatientsen
dc.subjectProlongation of Lifeen
dc.subjectRenal Dialysisen
dc.subjectResuscitationen
dc.subjectSurgeryen
dc.subjectSurveyen
dc.subjectTerminally Illen
dc.subjectTreatment Refusalen
dc.subjectTube Feedingen
dc.subjectVentilatorsen
dc.subjectWillsen
dc.titleLife-Sustaining Treatment Preferences of Hemodialysis Patients: Implications for Advance Directivesen
dc.provenanceDigital citation created by the National Reference Center for Bioethics Literature at Georgetown University for the BIOETHICSLINE database, part of the Kennedy Institute of Ethics' Bioethics Information Retrieval Project funded by the United States National Library of Medicine.en
dc.provenanceDigital citation migrated from OpenText LiveLink Discovery Server database named NBIO hosted by the Bioethics Research Library to the DSpace collection BioethicsLine hosted by Georgetown University.en


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