HomeHealth Sciences Journalvol. 7 no. 2 (2018)

Measuring the levels of knowledge and attitudes regarding advance directives of families of patients admitted in UERMMMCI: A descriptive cross-sectional study

Karlos Pio H. Alampay | Airah Gizelle A. Abacan | Jearwin C. Angeles | Jimuel D. Añonuevo | Ralph Lorenz R. Apilado | Bett Shannen M. Carpio | Monica Castro | Ma. Felilia Noela M. Cataquis | Kathleen Jessica S. Cheng | Christian Leo T. Chua | Jennifer M. Nailes



Introduction : Advance directives are documents by which a person makes provisions for health care decisions in the event that, in the future, that person becomes unable to make those decisions. There is a lack of studies on the knowledge and understanding towards advance directives among patients and their families. The purpose of this study is to address this lack of research regarding advance directives by measuring the level of knowledge and attitudes of families of hospitalized patients. Methods : A descriptive, cross-sectional study design was used to describe the attitudes and the level of knowledge on advance directives of the families of patients. Data were collected directly by the researchers via assisted questionnaires. Descriptive statistics and frequencies were reported. Results : A total of 79 participants consisting of immediate family members of patients from UERMMMCI were enrolled. Only 24% reported having discussed advance directives with the patient's physician. Those respondents whose families had no discussion with their physician about advance directives had the same score as those who had. Overall, 61% of participants have only medium to low knowledge of advance directives, while 70% have positive attitudes regarding advance directives. Conclusion : The study showed that the family members of patients had a reasonable understanding of advance directives in terms of basic knowledge, and positive attitudes on advance directives. Those who denied having discussed advance directives were comparable in the knowledge of advance directives with those who did.


  1. Kelley AS, Wenger NS, Sarkisian CA. Opiniones: end of life care preferences and planning among older Latinos. J Am Geriatr Soc 2011; 58(6): 1109-16. doi:10.1111/j.1532-5415.2010.02853.x
  2. Campbell LA, Kisely SR. Advance treatment directives for people with severe mental illness. Cochrane Database Syst Rev doi: 10.1002/14651858.CD005963.pub2
  3. Ashley RC. Why are advance directives legally important? Crit Care Nurse 2005; 25(4): 56-7.
  4. Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J 2014; 16(1): e12454. doi: 10.581/ircmj.12454
  5. Santiago MD. Advance Care Planning Education Act.
  6. Kim SS, Lee WH, Cheon JY, Lee JE, Yeo KS, Lee JH. Preferences for advance directives in Korea. Nurs Res Pract 2010; 2012. doi: 10.1155/2012/873892
  7. Jackson JM, Rolnick SJ, Asche SE, Heinrich RL. Knowledge, attitudes, and preferences regarding advance directives among patients of a managed care organization. Am J Manag Care 2009; 15(3): 177-86.
  8. Zhang Q, Xie C, Xie S, Liu Q. The attitudes of Chinese cancer patients and family care-givers toward advance directives. Int J Environ Res Public Health 2016; 13(8): E816. doi: 10.3390/ijerph13080816
  9. McAdam JL, Stotts NA, Padilla G, Puntillo K. Attitudes of critically ill Filipino patients and their families toward advance directives. Am J Crit Care 2005; 14(1): 17-25.
  10. Habal MV, Micevski V, Greenwood S, Delgado DH, Ross HJ. How aware of advanced care directives are heart failure patients, and are they using them? Canadian J Cardiol 2011; 27(3): 376-81. doi: 10.1016/j.cjca.2010.12.067
  11. Zheng RJ, Fu Y, Xiang QF, et al. Knowledge, attitudes, and influencing factors of cancer patients toward approving advance directives in China. Supportive Care Cancer 2016; 24(10): 4097-103. doi: 10.1007/s00520-016-3223-1.
  12. Sahm S, Will R, Hommel G. What are cancer patients' preferences about the treatment at the end of life and who should start talking about it? A comparison with healthy people and medical staff. Support Care Cancer 2005; 13(4): 206-14. Availa ble from: https://link.springer.com/article/10.1007/s00520-0040725-z