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The KoreanAdvance Directive Model and Factors Associated With Its Completion Among Patients With Hematologic Disorders

Lee, Mee Ok MSN, RN; Park, Jinny PhD, MD; Park, Eun Young PhD, RN, KONP; Kim, Youngji PhD, RN; Bang, Eunjoo PhD, RN; Heo, Seongkum PhD, RN; Kim, JinShil PhD, RN

Journal of Hospice & Palliative Nursing: August 2019 - Volume 21 - Issue 4 - p E10–E16
doi: 10.1097/NJH.0000000000000522
Global Exemplar Series
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The objective of this pilot study was to examine factors associated with the completion of advance directives (ADs) among patients with hematologic disorders in Korea. Using a descriptive design, patients with largely hematologic malignancies completed the questionnaires, including the KoreanAdvance Directive (K-AD) model, which pertains to values, treatment wishes, and proxy appointment. Of 45 patients (aged 48.7 ± 10.7 years, 51.1% men), two-thirds had leukemia (40.0%) and lymphoma (26.7%). “Dying comfortably” was the most frequently selected value (n = 20). Regarding treatment wishes, hospice care was the most desired type (n = 22), whereas aggressive treatments, such as cardiopulmonary resuscitation, were less preferred (n = 3). The patient’s spouse was most frequently appointed as a proxy (n = 27). Patients who completed all the 3 components of the K-AD model (51.1%) were less depressed (t = −2.31; P = .028) and more likely to perceive the benefits of the K-AD model (t = 2.07; P = .045), compared with the noncompleters (48.9%). Further, being male (odds ratio [OR], 6.42; P = .031), having higher scores on depressive symptoms (OR, 1.28; P = .016), and perceived barriers (OR, 1.08; P = .040) were associated with lower tendency to complete the K-AD model. These findings support the need for earlier introduction of ADs in hematologic disorders, with consideration of modifiable factors such as depression or barriers to end-of-life care decisions.

Mee Ok Lee, MSN, RN, is nurse manager, Gachon University Gil Medical Center, Incheon, South Korea.

Jinny Park, PhD, MD, is professor, Gachon University College of Medicine, and Department of Internal Medicine, Gil Medical Center, Incheon, South Korea.

Eun Young Park, PhD, RN, KONP, is associate professor, College of Nursing, Gachon University, Incheon, South Korea.

Youngji Kim, PhD, RN, is assistant professor, College of Nursing and Health, Kongju National University, Chungcheongnam-do, South Korea.

Eunjoo Bang, PhD, RN, is assistant professor, College of Nursing, Gachon University, Incheon, South Korea.

Seongkum Heo, PhD, RN, is associate professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock.

JinShil Kim, PhD, RN, is professor, College of Nursing, Gachon University, Incheon, South Korea.

Address correspondence to JinShil Kim, PhD, RN, College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, South Korea (kimj317503@gmail.com).

The authors have no conflicts of interest to disclose.

Online date: March 6, 2019

© 2019 by The Hospice and Palliative Nurses Association.