Knowledge and awareness of their condition and advance directives documents among patients with decompensated progressive chronic diseases presenting at Emergency Departments

Aims and purpose: To analyse, among patients with chronic conditions

attending the Emergency Departments, the degree of

awareness and knowledge regarding various aspects of the natural

course of their conditions and whether there are factors associated

thereto, as well as their personal position regarding various aspects

of the so-called ¡°Vital Testament¡±, their predisposition to prepare such

a document and eventual factors associated thereto.

Material and methods: The study population included patients with diverse

chronic diseases, the natural course of which might entail a shortening of

their life expectancy, who attended a hospitalary Outpatient Emergency Department.

Clinico-epidemiological features were recorded and a survey questionnaire

was administered with items regarding their degree of knowledge

about their condition and about the ¡°Vital Testament¡±. The independent variables

were the good or bad knowledge of the evolutive possibilities of their

condition and their predisposition to prepare or not a ¡°Vital Testament¡±; and

an assessment was performed regarding whether there was any vlinico-epidemiological

or opinion variable associated to the independent variables.

Results: One hundred and sixty patients were interviewed (age range 74

¡À 11 years; 67% females). Forty-seven per cent of them evidenced good

knwoledge of their conditions, in association with age ¡Ü70 years (p<0.001) and with previous admission into an Intensive Care Unit (p<0.001). Despite this, 78% of the interviewed patients considered themselves to be overall well informed by their usual attending medical teams, and only 38% wished to receive further information. Previous knowledge about what a ¡°Vital Testament¡± is and entails was present in 19% of the patients, and only 3% stated that their attending physicians had talked to them about it. Fifty percent of the patients declared themselves willing to prepare such a dicument, and there was not any factor associated to such predisposition. Conclusions: Among patients with chronic conditions attending Emergency Departments there is an insufficient degree of awareness and knowledge regarding their conditions, and an even poorer one regarding their possibility to prepare a ¡°Vital Testament¡± (Anticipated Last Will) document.