Content of the advance directives form of the pain and palliative care services in Colombia. Cross-sectional study

  • Ana Milena Álvarez Acuña Department of Pain Medicine and Palliative Care, Hospital de San José, Fundación Universitaria de Ciencias de la Salud. Bogotá, Colombia. https://orcid.org/0000-0003-4306-4533
  • Claudia Liliana Buitrago Martín Department of Pain Medicine and Palliative Care, Hospital de San José, Fundación Universitaria de Ciencias de la Salud. Bogotá, Colombia. https://orcid.org/0000-0002-4747-0662
  • Alejandra Ceballos Vejarano Department of Pain Medicine and Palliative Care, Hospital de San José, Fundación Universitaria de Ciencias de la Salud. Bogotá, Colombia. https://orcid.org/0000-0002-0559-0666
Keywords: Advance directives document, Forms, Advance directives, End-of-life care, Advance care planning, Colombia

Abstract

Introduction: The scientific literature supports the limited effect of the Advance Directives Document (ADD) in clinical decision-making. There are implementation barriers that prevent the fulfillment its purpose. The content of the ADD has not been explored in Colombia.

Objective: To describe the contents of the ADD used in the pain and palliative care services.

Methods. Cross-sectional study. Based on the national legislation and the rights that may be included in an ADD as described in the scientific literature, a checklist was designed with 20 variables to assess the forms, collecting data on the legal validity criteria and the contents for specific clinical and ethical directives.  A predefined scale was used to describe the overall content of the form.

Results: A total of 24 forms around the country were analyzed; the most comprehensive document included 14 of the 20 variables evaluated. In accordance with the definition used, 70 % of the forms had a maximum of 10 variables and were classified as “low content”. Four forms were not formalized and only the forms formalized before the treating physician met the legal standard. 50 % of the forms included closed statements.

Conclusions: The ADD forms exhibit a number of inadequacies in terms of the legal and clinical criteria for a high quality content, leading to difficulties for their applicability in the clinical setting. In Colombia, a standard form validated by the palliative care associations is required. 

References

Singer PA, Thiel EC, Salit I, Flanagan W, Naylor CD. The HIV-specific advance directive. J Gen Intern Med. 1997;12(12):729-35. doi: https://doi.og/10.1046/j.1525-1497.1997.07157.x.

Blanco LG. Directivas Anticipadas. En: J. C. Tealdi, eds. Diccionario Latinoamericano de bioética [internet]. Bogotá: UNESCO, Universidad Nacional de Colombia; 2008 [cited: 2023 Jan 24]. p. 425-7. Available at: https://www.salud.gob.ec/wp-content/uploads/2016/12/8.-Diccionario-latinoamericano-de-Bio %C3 %A9tica-UNESCO.pdf.

Olick RS. On the scope and limits of advance directives and prospective autonomy. En: Lack P, Biller-Andorno N, Brauer S, eds. International Library of Ethics, Law, and the New Medicine, vol 54. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7377-6_4.

Beauchamp TL, Childress JF. Principles of biomedical ethics. Oxford University Press; 2001.

Teno JM, Licks S, Lynn J, Wenger N, Connors AF, Phillips RS, et al. Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc. 1997;45(4):508-12. doi: https://doi.org/10.1111/j.1532-5415.1997.tb05179.x.

Moore N, Detering KM, Low T, Nolte L, Fraser S, Sellars M. Doctors’ perspectives on adhering to advance care directives when making medical decisions for patients: an Australian interview study. BMJ Open. 2019;9(10):e032638. doi: https://doi.org/10.1136/bmjopen-2019-032638.

Emanuel L. How living wills can help doctors and patients talk about dying. BMJ. 2000;320(7250):1618-9. doi: https://doi.org/10.1136/bmj.320.7250.1618.

Herreros B, Benito M, Gella P, Valenti E, Sánchez B, Velasco T. Why have advance directives failed in Spain? BMC Med Ethics. 2020;21(1):113. doi: https://doi.org/10.1186/s12910-020-00557-4.

Lasmarías C, Delgado Girón S, Rietjens JAC, Korfage IJ, 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://doi.org/10.20986/medpal.2019.1019/2019.

Congreso de la República de Colombia. Ley 1733 de 2014 [Internet]. Bogotá; 2014 [cited: 2022 May 04]. Available at: http://www.secretariasenado.gov.co/senado/basedoc/ley_1733_2014.html.

Ministerio de Salud y Protección Social. Resolución 2665 de 2018 [Internet]. Bogotá; 2018 [cited: 2022 May 04]. Available at: https://www.minsalud.gov.co/Normatividad_Nuevo/Resoluci %C3 %B3n %20No. %202665 %20de %202018.pdf.

Álvarez Acuña AM, Gomezese Ribero ÓF. Advance directives document: knowledge and experiences of healthcare professionals in Colombia. Colombian Journal of Anesthesiology. 2022;50(2):e1012. doi: https://doi.org/10.5554/22562087.e1012.

Bolívar Góez PL, Gómez Córdoba AI. Advanced wishes for the end of life.An approach from the Colombian regulation and in comparative law. Rev Latinoam Bioet. 2015;16(30-1):128-53. doi: https://doi.org/10.18359/rlbi.1444.

Siurana Aparisi JC. La idea de sujeto en la ética del discurso de Kart-Otto Apel aplicada al problema de las directrices anticipadas en el ámbito de la ética biomédica. Valencia: Universitat de València; 2001. Disponible en: https://roderic.uv.es/handle/10550/15476?show=full.

Lambert P, Gibson JM, Nathanson P. The values history: an innovation in surrogate medical decision-making. Law Med Health Care. 1990;18(3):202-12. doi: https://doi.org/10.1111/j.1748-720x.1990.tb00023.x.

Doukas DJ, McCullough LB. The values history. The evaluation of the patient's values and advance directives. J Fam Pract. 1991;32(2):145-53.

Howard Zuluaga MA. Las declaraciones de voluntad anticipada y la autonomía de la persona. Rev Derecho. 2012;11(21):171-94.

Ministerio de Salud y Protección Social. Resolución 0971 de 2021 [Internet]. Bogotá; [cited: 2022 May 10]. Available at: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-971-de-2021.pdf

Buck K, Nolte L, Sellars M, Sinclair C, White BP, Kelly H, et al. Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expect. 2021;24(4):1312-25. doi: https://doi.org/10.1111/hex.13264.

Nauck F, Becker M, King C, Radbruch L, Voltz R, Jaspers B. To what extent are the wishes of a signatory reflected in their advance directive: a qualitative analysis. BMC Medical Ethics. 2014;15:52. doi: https://doi.org/10.1186/1472-6939-15-52.

Álvarez Acuña AM, Riaño Moreno JC, López Neira J, Gomezese Ribero OF. Ethical principles and dilemmas in the discourse of healthcare practitioners involved with end-of-life care based on the Advanced Directives Document. Colombian Journal of Anesthesiology. 2022;51(1):e1046. doi: https://doi.org/10.5554/22562087.e1046.

Hemsley B, Meredith J, Bryant L, Wilson NJ, Higgins I, Georgiou A, et al. An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation. Patient Educ Couns. 2019;102(6):1067-79. doi: https://doi.org/10.1016/j.pec.2019.01.007.

Luckett T, Bhattarai P, Phillips J, Agar M, Currow D, Krastev Y, et al. Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria. Aust Health Rev. 2015;39(5):552-60. doi: https://doi.org/10.1071/AH14187.

Barker PC, Holland NP, Shore O, Cook RL, Zhang Y, Warring CD, et al. The effect of health literacy on a brief intervention to improve advance directive completion: A randomized controlled study. J Prim Care Community Health. 2021;12:21501327211000221. doi: https://doi.org/10.1177/21501327211000221.

Rietjens J, Korfage I, Taubert M. Advance care planning: the future. BMJ Support Palliat Care. 2021;11(1):89-91. doi: https://doi.org/10.1136/bmjspcare-2020-002304.

Dittborn Bellalta M. Palliative Care professionals knowledge and attitudes regarding Advance Directives in Metropolitan Region, Chile. Rev Col Bioet. 2018;13(2):36.49. doi: https://doi.org/10.18270/rcb.v13i2.2393.

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.

Zwakman M, van Delden JJM, Caswell G, Deliens L, Ingravallo F, Jabbarian LJ, et al. Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention: insights gained from the ACTION trial. Support Care Cancer. 2020;28(3):1513-22. doi: https://doi.org/10.1007/s00520-019-04956-1.

Richard A, Richard J, Johnston W, Miyasaki J. Readability of advance directive documentation in Canada: a cross-sectional study. CMAJ Open. 2018;6(3):E406-E11. doi: https://doi.org/10.9778/cmajo.20180037.

Mueller LA, Reid KI, Mueller PS. Readability of state-sponsored advance directive forms in the United States: a cross sectional study. BMC Med Ethics. 2010;11:6. doi: https://doi.org/10.1186/1472-6939-11-6.

Sudore RL, Landefeld CS, Barnes DE, Lindquist K, Williams BA, Brody R, et al. An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns. 2007;69(1-3):165-95. doi: https://doi.org/10.1016/j.pec.2007.08.015.

Ott BB, Hardie TL. Readability of advance directive documents. Image J Nurs Sch. 1997;29(1):53-7. doi: https://doi.org/10.1111/j.1547-5069.1997.tb01140.x.

How to Cite
1.
Álvarez Acuña AM, Buitrago Martín CL, Ceballos Vejarano A. Content of the advance directives form of the pain and palliative care services in Colombia. Cross-sectional study . Colomb. J. Anesthesiol. [Internet]. 2023 Nov. 21 [cited 2024 Feb. 28];. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1093

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2023-11-21
How to Cite
1.
Álvarez Acuña AM, Buitrago Martín CL, Ceballos Vejarano A. Content of the advance directives form of the pain and palliative care services in Colombia. Cross-sectional study . Colomb. J. Anesthesiol. [Internet]. 2023 Nov. 21 [cited 2024 Feb. 28];. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1093
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