Advance Directives Document: knowledge and experiences of healthcare professionals in Colombia

  • Ana Milena Álvarez Acuña Postgraduate in Anesthesiology and Resuscitation, Universidad Industrial de Santander. Bucaramanga, Colombia. https://orcid.org/0000-0003-4306-4533
  • Ómar Fernando Gomezese Ribero a. Postgraduate in Anesthesiology and Resuscitation, Universidad Industrial de Santander. Bucaramanga, Colombia. b. Pain and Palliative Care Clinic, Fundación Cardiovascular de Colombia. Floridablanca, Colombia. https://orcid.org/0000-0003-4490-7766
Keywords: Advanced directives, Healthcare professional experiences, Dignified death, Living will, Autonomy, Planning for advanced directives, Colombia, Anesthesiology

Abstract

Introduction: The Advanced Directives Document (ADD) is a bioethical quality benchmark for healthcare and assurance of compliance with the rights of autonomy, self-determination and dignity of the patient. This document was established over the past decade and currently there is no evidence about the attitudes and knowledge of the healthcare professionals with regards to the use of this tool in clinical practice in Colombia.

Objective: To describe the knowledge and experiences of healthcare professionals members of six Colombian Scientific Societies regarding the right to sign an ADD and explore the barriers to its applicability in clinical daily practice.

Methods: Descriptive, cross-sectional study conducted using an anonymous and voluntary e-survey with the participation of six Colombian Medical Societies. A questionnaire was designed comprising five groups of variables: general, ADD knowledge, medical experiences and personal experiences regarding advanced directives and potential obstacles to its implementation.

Results: 533 professionals participated in the survey. 54 % (n = 286) expressed their lack of awareness about the fact that there is law governing the ADD in Colombia; 34.33 % (n = 183) said they were familiar with the requirements of the document. Over the last year, 24 % of the professionals received one or more ADDs from their patients. Only 11.7 % of healthcare practitioners had themselves completed an ADD. 77.1 % of the professionals surveyed believe that the number of individuals with an ADD has not changed after the approval and regulation of the right to an advanced directives document. 86.6 % of the practitioners said they respected the ADD, notwithstanding the fact that the patient could benefit otherwise.

Conclusions: The overall perception of healthcare professionals with regards to the number of ADDs signed by patients is that the number has not changed after the approval of the Law in Colombia. This study evidenced that medical practitioners have a poor knowledge about the ADD and that there is a need to educate healthcare professionals about the ADD and to promptly implement institutional programs about Planning of Advanced Directives (PAD). Both strategies are challenging for the applicability of AD in Colombia.

References

Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. New York: Oxford University; 2001.

Corte Constitucional de Colombia. Sentencia N.° T-401/94 [Internet]. [citado: 2021 jun. 8]. Disponible en: https://www.corteconstitucional.gov.co/relatoria/1994/T-401-94.htm

Martínez VM, Olmos A. De la autonomía personal al consentimiento informado y las voluntades anticipadas. Boletín Mexicano de Derecho Comparado [internet]. 2016. [citado: 2021 jun. 8]. Disponible en: http://www2.juridicas.unam.mx/2016/02/10/de-la-autonomia-personal-al-consentimiento-informado-y-las-voluntades-anticipadas/

Lifshitz A. El consentimiento informado: Aplicación en la práctica de la medicina. Revista CONAMED. 2004;9(3):23-5. https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=79871

Lack P, Biller-Andorno N, Brauer S. On the Scope and limits of advance directives and prospective autonomy. En: Advance directives. International library of ethics, law, and the new medicine. Editorial Board; 2014. pp. 53-71. https://doi.org/10.1007/978-94-007-7377-6

Corte Constitucional de Colombia. Sentencia T-970/14 [Internet]. [citado: 2021 jun. 8]. Disponible en: https://www.corteconstitucional.gov.co/relatoria/2014/t-970-14.htm

Corte Constitucional de Colombia. Sentencia C-239/97 [Internet]. [citado: 2021 jun. 8]. Disponible en: https://www.corteconstitucional.gov.co/relatoria/1997/c-239-97.htm#:~:text=%22Homicidio%20por%20piedad.,seis%20meses%20a%20tres%20a%C3%B1os%22

Congreso de la Republica de Colombia. Ley 1733 de 2014 [Internet]. [citado: 2021 jun. 8]. Disponible en: http://www.secretariasenado.gov.co/senado/basedoc/ley_1733_2014.html

Ministerio de Salud y Protección Social de Colombia. Resolución 1051 de 2016 [Internet]. [citado: 2021 jun. 3]. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%201051%20de%202016.pdf

Ministerio de Salud y Protección Social de Colombia. Resolución 2665 de 2018 [Internet]. [citado: 2021 jun. 8]. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%202665%20de%202018.pdf

Yllera C. ¿Cumplimos nuestros deberes respecto a los Documentos de Voluntades Anticipadas? Revista de Bioética y Derecho. 2014;32:82-94. http://scielo.isciii.es/pdf/bioetica/n32/08_articulo7.pdf

Aguilar-Sánchez JM, Cabañero-Martínez MJ, Puerta F, Ladios-Martín M, Fernández-de-Maya J, Cabrero-García J. Grado de conocimiento y actitudes de los profesionales sanitarios sobre el documento de voluntades anticipadas. Gac Sanit. 2018;32(4):339-45. doi: https://doi.org/10.1016/j.gaceta.2017.08.006

Forero J, Vargas I, Bernales M. Voluntades anticipadas: desafíos éticos en el cuidado del paciente. Pers Bioet. 2019;23(2):224-44. doi: https://doi.org/10.5294/pebi.2019.23.2.5

Peicius E, Blazeviciene A, Kaminskas R. ¿Son útiles las directivas anticipadas para una buena toma de decisiones al final de la vida? Una encuesta transversal de profesionales de la salud. BMC Med Ethics. 2017;18:40. doi: https://doi.org/10.1186/s12910-017-0197-6

Herreros B, Benito M, Gella P, et al. Why have Advance Directives failed in Spain? BMC Med Ethics. 2020;21(113):2-13. doi: https://doi.org/10.1186/s12910-020-00557-4

Altisent R. Planificación anticipada de la asistencia. Se necesita una revolución educativa. Editorial Aten Primaria. 2013;45(8):402-3. doi: http://dx.doi.org/10.1016/j.aprim.2013.08.001

Zunzunegui MV. Los cuidados al final de la vida. Gac Sanit. 2018;32(4):319-20. doi: https://doi.org/10.1016/j.gaceta.2018.04.007

Andrés-Pretel F, Navarro Bravo B, Párraga Martínez I, Torre García MA, Jiménez del Val MD, López-Torres HJ. Conocimientos y actitudes de los mayores hacia el documento de voluntades anticipadas. Gac Sanit. 2012;26(6):570-3. doi: https://www.doi.org/10.1016/j.gaceta.2011.12.007

Nebot C, Ortega B, Mira JJ, Ortiz L. Morir con dignidad. Estudio sobre voluntades anticipadas. Gac Sanit. 2010;24(6):437-45. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112010000600002

Sarmiento-Medina MI, Vargas-Cruz SL, Velásquez-Jiménez CM, Sierra M. Problemas y decisiones al final de la vida en pacientes con enfermedad en etapa terminal. Rev Salud Pública. 2012;14(1):116-28. doi: https://scielosp.org/pdf/rsap/2012.v14n1/116-128

Carrillo González S, Gómez JL. Conocimiento acerca de las voluntades anticipadas por parte del adulto mayor del Hogar San Pedro Claver 2015-2016. Ciencia y Salud Virtual. 2017;9(2):57-66. doi: https://doi.org/10.22519/21455333.952

Mira JJ, Lorenzo S, Vitaller J, Guilabert M. Derechos de los pacientes. Algo más que una cuestión de actitud Gac Sanit. 2010;24(3):247-50. doi: https://www.doi.org/10.1016/j.gaceta.2010.01.012

Ministerio de Salud y Protección Social. Resolución 13437 del 1991 [Internet]. [citado: 2021 jun. 8]. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/RESOLUCI%C3%93N%2013437%20DE%201991.pdf

Bolívar PL, Gómez AI. Voluntades anticipadas al final de la vida. Una aproximación desde la regulación colombiana y en el derecho comparado. Rev Latinoam Bioet. 2016;1:128-53. doi: http://dx.doi.org/10.18359/rlbi.1444

Calvache J, Moreno S, Prue G, Reid J, Ahmedzai S, Arango-Gutiérrez A, et al. Knowledge of end-of-life wishes by physicians and caregivers in cancer patients. BMC Palliative Care. 2021. Online ahead of print. doi: https://doi.org/10.21203/rs.3.rs-493247/v1

Lasmarías C, Delgado S, Rietjens J, Korfage I, Gómez-Batiste X. Definición y recomendaciones para la planificación de decisiones anticipadas: un consenso internacional apoyado por la European Association for Palliative Care (EAPC) Med Paliat. 2019;26(3):236-49. doi: https://www.doi.org/10.20986/medpal.2019.1019/2019

Korfage IJ, Carreras G, Arnfeldt Christensen CM, Billekens P, Bramley L, Briggs L, et al. Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial. PLoS Med. 2020;17(11):e1003422. doi: https://doi.org/10.1371/journal.pmed.1003422

How to Cite
1.
Álvarez Acuña AM, Gomezese Ribero Ómar F. Advance Directives Document: knowledge and experiences of healthcare professionals in Colombia. Colomb. J. Anesthesiol. [Internet]. 2022Apr.1 [cited 2022May20];50(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1012

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Published
2022-04-01
How to Cite
1.
Álvarez Acuña AM, Gomezese Ribero Ómar F. Advance Directives Document: knowledge and experiences of healthcare professionals in Colombia. Colomb. J. Anesthesiol. [Internet]. 2022Apr.1 [cited 2022May20];50(2). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1012
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