Grade of knowledge about the advance directive document by the chronic patient who comes to the emergency department

Objective: To evaluate the patient's and their caregiver's knowledge of the advance directive document (ADD) in patients with chronic diseases who come to the emergency department due to decompensation and their caregivers. To discover the patient's willingness and associated factors to draw up an ADD. Matirial and methods: A descriptive cohort study including patients with an acutely decompensated chronic evolving disease attending the ED medicine section at an urban tertiary teaching hospital was performed. The patients' demographic and clinical variables were recorded. After control of their symptoms, an anonymous structured oral interview was also administered. Dependent variables included were previous knowledge of the ADD, and the patient willingness to draw it up. The relationship among independent and dependent variables was analyzed. Results: A total of 380 people (190 patients and 190 carers) were analyzed. Compared with patients, carers were more frequently women (76% vs 42%, p < 0.001), younger (58 +/- 15 vs 73 +/- 12, p < 0.001), and had a better knowledge of the disease (88% vs 74%, p < 0.001) and of the ADD (28% vs 16%, p < 0.001). Only 5% of the patients had received ADD information from their physician. The only factor associated with the patients' previous knowledge of the ADD was to have completed at least secondary school (p < 0.05). Forty-six percent of patients were favorable to the drawing up of an ADD. The only variable associated with such a willingness was to be 70 or younger (p < 0.05). Eighty-eight percent of the patients were in favor of the distribution of information leaflets in the ED. Conclusions: There is poor patient and carer knowledge regarding the ADD among patients with chronic diseases. Nonetheless, almost half of patients would be willing to draw up an ADD. EDs can contribute to improve the information about it. (C) 2009 Elsevier Espana, S.L. All rights reserved.