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Advance directives in the context of end-of-life palliative care

Pérez, Marisa del V.a,b; Macchi, Marina J.a; Agranatti, Alejo F.a

Current Opinion in Supportive and Palliative Care: December 2013 - Volume 7 - Issue 4 - p 406–410
doi: 10.1097/SPC.0000000000000007
END-OF-LIFE MANAGEMENT: Edited by Gustavo de Simone
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Purpose of review To review the definition of advanced directive, understand the implications for the patient, family and healthcare team, and address the obstacles involved in the implementation.

Recent findings Advanced directives propose a model of healthcare based on patient preferences. Although there is sufficient evidence related to their usefulness, various factors are known to affect the use of advanced directives. Therefore, rules need to be established in order to optimize the implementation process.

Summary An advanced directive is a legal document based on the principle of autonomy that expresses the desire of the patient in relation to different medical treatments when the patient is unable to make those decisions. The advanced directives are represented in three formats: Living Will, Appointment of a Healthcare Proxy and Legal Status of Preferences. The uses of advanced directives have an impact not only on the patients and their families, but also on the healthcare team. Despite their utility being well known, there are several general barriers that affect implementation, as well as factors related to characteristics of each study population.

aPalliative Care Team, Department of Clinical, C Bonorino Udaondo Gastroenterology Hospital

bPallium Latinoamerica, Bonpland, Buenos Aires, Argentina

Correspondence to Marisa del Valle Pérez, Palliative Care Team, Department of Clinical, ‘Carlos Bonorino Udaondo Gastroenterology, Hospital’, Av Caseros 2061, (C1264AAA) Buenos Aires, Argentina. E-mail: pvmarisa@gmail.com.ar

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins