Advance directives in dialysis patients

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  • Tsubata Yutaka
    Department of Internal Medicine, Niigata Prefectural Central Hospital
  • Tanabe Shigeyo
    Department of Internal Medicine, Niigata Prefectural Central Hospital
  • Ajiro Jyunya
    Department of Internal Medicine, Niigata Prefectural Central Hospital
  • Tsubata Chikako
    Department of Internal Medicine, Niigata Prefectural Central Hospital
  • Akiyama Fumihiro
    Department of Internal Medicine, Niigata Prefectural Central Hospital

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Other Title
  • 透析患者を対象とした事前指示書の検討
  • トウセキ カンジャ オ タイショウ ト シタ ジゼン シジショ ノ ケントウ

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Background : Recently, interest in advance directives (ADs) has risen with respect to the patient's right of self-determination and various problems with end-of-life decision-making. However, there are many administrative problems that should be resolved, such as confirmation or restatement and assessment of decision-making capacity. Those problems could be resolved in dialysis patients who must be continuously involved with dialysis facilities throughout their life. We, therefore, conducted an attitude survey regarding terminal care among hemodialysis patients (HDs) and predialysis chronic kidney disease patients (non-HDs) in our hospital to investigate whether dialysis patients were better suited for advance directives. Material and Methods : We conducted an anonymous questionnaire survey among one hundred thirty HDs (collection rate 70.8%) and one hundred non-HDs in January and March 2009. Results : The rate of patients familiar with ADs among HDs (22.6%) was greater than that among non-HDs (11.1%) (p=0.022), and the rates of patients who wanted to make an AD were 48.8% and 41.8% among HDs and non-HDs, respectively. The rates of patients who had talked with someone about end-of-life decision were 21.7% and 19.8%, among HDs and non-HDs, respectively. The rate of patients who clearly express their wishes about receiving artificial feeding when the ability to communicate was judged to have been irreversibly lost was greater among HDs (54.6%) than among non-HDs (22.5%) (p=0.001). In the superscription situation, the rate of patients who clearly expressed their wishes about the continuation or withdrawal of dialysis in HDs was 60.7%. Conclusions : Among HDs, the rate of applicants making ADs reached 48.8%, and there were more patients who could clearly express their wishes about end-of-life decisions compared to that among non-HDs. Therefore, it was thought that dialysis patients were better suited for advance directives.

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