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Knowledge and attitude towards advance directives for patients with terminal illnesses among doctors working in a tertiary care hospital.

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Title: Knowledge and attitude towards advance directives for patients with terminal illnesses among doctors working in a tertiary care hospital.
Authors: Jacob JA; Department of Psychiatry , Christian Medical College (CMC), Vellore, Tamil Nadu, India., P T; Department of Psychiatry , Christian Medical College (CMC), Vellore, Tamil Nadu, India., Jawaharlal GRJ; Department of Biostatistics, Christian Medical College (CMC), Vellore, Tamil Nadu, India., Kuruvilla A; Department of Psychiatry , Christian Medical College (CMC), Vellore, Tamil Nadu, India., Gopalakrishnan R; Department of Psychiatry , Christian Medical College (CMC), Vellore, Tamil Nadu, India.
Source: The National medical journal of India [Natl Med J India] 2026 May-Jun; Vol. 39 (3), pp. 140-146.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: All India Institute Of Medical Sciences Country of Publication: India NLM ID: 8809315 Publication Model: Print Cited Medium: Internet ISSN: 2583-150X (Electronic) Linking ISSN: 0970258X NLM ISO Abbreviation: Natl Med J India Subsets: MEDLINE
Imprint Name(s): Publication: New Delhi : All India Institute Of Medical Sciences
Original Publication: New Delhi : Published by S. Nundy, produced and distributed by Oxford University Press, [c1988-
MeSH Terms: Advance Directives*/psychology , Advance Directives*/ethics , Physicians*/psychology , Physicians*/statistics & numerical data , Terminal Care*/psychology , Attitude of Health Personnel* , Health Knowledge, Attitudes, Practice* , Terminally Ill*, Humans ; Male ; Tertiary Care Centers ; Female ; India ; Adult ; Surveys and Questionnaires ; Middle Aged
Abstract: Background Advance directives help strike a balance between the ethical concepts of paternalism and patient autonomy in medical practice. It supports end-of-life decisions by the patient within an appropriate legal and ethical framework. This concept is still in its infancy in India and is an under-researched area. We aimed to assess the knowledge and attitudes of medical professionals on advance directives in a tertiary care teaching hospital. Methods Medical doctors from all departments were invited to participate in this survey using systematic sampling. The knowledge and attitude questionnaire was administered after obtaining informed consent. Socio-demographic and professional details were also collected. Descriptive, bivariate, and multivariate statistics were obtained using SPSS version 16.0.1. Results Our study included 391 medical doctors; 168 (43%) had good knowledge of advance directives, and 129 (33%) had a positive attitude towards them. Doctors who had completed postgraduate training in their specialty had better knowledge. Positive attitudes to advance directives were associated with greater knowledge and working in a super specialty department, while negative attitudes were associated with being more religious. Conclusion The level of knowledge and attitudes towards advance directives among medical practitioners is inadequate. While training will help improve knowledge and attitudes, other socio-cultural factors may also influence the same.
References: Beauchamp TL, Childress JF. 4th ed ed. New York: Oxford University Press; 1994.
The principle of beneficence in applied ethics [Internet]. 2019 Available from:.
Mandal J, Ponnambath DK, Parija SC. Utilitarian and deontological ethics in medicine. Trop Parasitol. 2016; 6:5-7. doi:10.4103/2229-5070.175024. PMID:26998430.
Arruda LM, Abreu KPB, Santana LBC, Sales MVC. Variables that influence the medical decision regarding advance directives and their impact on end-of-life care. Einstein (Sao Paulo). 2019; 18:eRW4852. doi:10.31744/einstein_journal/2020RW4852. PMID:31618287.
Hickman SE, Lum HD, Walling AM, Savoy A, Sudore RL. The care planning umbrella: The evolution of advance care planning. J Am Geriatr Soc. 2023; 71:2350-6. doi:10.1111/jgs.18287. PMID:36840690.
Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manag. 2017; 53:821-32. doi:10.1016/j.jpainsymman.2016.12.331. PMID:28062339.
McMahan RD, Knight SJ, Fried TR, Sudore RL. Advance care planning beyond advance directives: Perspectives from patients and surrogates. J Pain Symptom Manag. 2013; 46:355-65. doi:10.1016/j.jpainsymman.2012.09.006. PMID:23200188.
Morrison RS, Meier DE, Arnold RM. What's wrong with advance care planning?. JAMA. 2021; 326:1575-6. doi:10.1001/jama.2021.16430. PMID:34623373.
Grant MS, Back AL, Dettmar NS. Public perceptions of advance care planning, palliative care, and hospice: A scoping review. J Palliat Med. 2021; 24:46-52. doi:10.1089/jpm.2020.0111. PMID:32614634.
Definition of advance directives [Internet]. 2023 Available from:.
Breu A. Advance directives. Hosp Med Clin. 2012; 1:e254-e264. doi:10.1016/j.ehmc.2012.03.004.
Kelley K. The Patient Self-Determination Act: A matter of life and death. Physician Assist. 1995; 19:53-6.
The Constitution of India [Internet]. 2020 Available from:.
Living wills are now legally binding but might be still hard to implement [Internet]. 2022 Available from:.
Brassington I. How not to talk about passive euthanasia: A lesson from India. Indian J Med Ethics. 2021; VI:1-11. doi:10.1186/s12910-020-00481-7. PMID:32410605.
Brassington I. What passive euthanasia is. BMC Med Ethics. 2020; 21:41. doi:10.1186/s12910-020-00481-7. PMID:32410605.
Common Cause (A Regd Society) vs Union of India (A) Ministry of Health on 24 January 2023 [Internet]. Available from:.
Gursahani R, Salins N, Bhatnagar S, Butola S, Mani RK, Mehta D, et al. Advance Care Planning in India: Current status and future directions. A short narrative review. Z Evid Fortbild Qual Gesundhwes. 2023; 180:64-7. doi:10.1016/j.zefq.2023.04.011. PMID:37353428.
Dhru K, Ghooi R. Advance directives across Asia, a comparative socio-legal analysis. Cambridge: Cambridge University Press; 2023. doi:10.1017/9781009152631.008.
Davidson KW, Hackler C, Caradine DR, McCord RS. Physicians' attitudes on advance directives. JAMA. 1989; 262:2415-19. doi:10.1001/jama.1989.03430170077032. PMID:2795827.
Poveda-Moral S, de la Casa PJ, Sánchez-Valero P, Pomares-Quintana N, VicenteGarcía M, Falcó-Pegueroles A. Association between knowledge and attitudes towards advance directives in emergency services. BMC Med Ethics. 2021; 22:75. doi:10.1186/s12910-021-00646-y. PMID:34158034.
AlFayyad IN, Al-Tannir MA, AlEssa WA, Heena HM, Abu-Shaheen AK. Physicians and nurses' knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia. PLoS One. 2019; 14:e0213938. doi:10.1371/journal.pone.0213938. PMID:30978182.
Shruthi P, Sudaakar G. Knowledge and attitude towards euthanasia and advance directives amongst medical students in a private medical college and hospital at a metropolitan city of India. Indian J Forensic Med Toxicol. 2021; 15:457-61. doi:10.37506/ijfmt.v15i2.14351.
Toro Flores R, Silva Mato A, Piga Rivero A, Alfonso Galán MT. Conocimientos y actitudes de médicos y enfermeras sobre las instrucciones previas [Knowledge and attitudes about advance directives on physicians and nurses]. Aten Primaria. 2013; 45:404-8. doi:10.1016/j.aprim.2013.03.003. PMID:23827795.
Huber S, Huber O. The centrality of religiosity scale (CRS). Religions. 2012; 3:710-23. doi:10.3390/rel3030710.
Wahidiyat PA, Yo EC, Wildani MM, Triatmono VR, Yosia M. Cross-sectional study on knowledge, attitude and practice towards thalassaemia among Indonesian youth. BMJ Open. 2021; 11:e054736. doi:10.1136/bmjopen-2021-054736. PMID:34862299.
Funk DC, Moss AH, Speis A. How COVID-19 changed advance care planning: Insights from the West Virginia Center for End-of-Life Care. J Pain Symptom Manag. 2020; 60:e5-e9. doi:10.1016/j.jpainsymman.2020.09.021. PMID:32976940.
Gupta A, Bahl B, Rabadi S, Mebane A 3rd, Levey R, Vasudevan V. Value of advance care directives for patients with serious illness in the era of COVID pandemic: A review of challenges and solutions. Am J Hosp Palliat Care. 2021; 38:191-8. doi:10.1177/1049909120963698. PMID:33021094.
O'Sullivan R, Mailo K, Angeles R, Agarwal G. Advance directives: Survey of primary care patients. Can Fam Physician. 2015; 61:353-6.
Nilsson ME, Maciejewski PK, Zhang B, Wright AA, Trice ED, Muriel AC, et al. Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children. Cancer. 2009; 115:399-409. doi:10.1002/cncr.24002. PMID:19110677.
Martínez Gimeno ML, Cámara Escribano C, Honrubia Fernández T, Olmo García MC, Tovar Benito DH, Bilbao-Goyoaga Arenas T, et al. Knowledge and attitudes of healthcare professionals in advance healthcare directives. J Healthc Qual Res. 2018; 33:270-7. doi:10.1016/j.jhqr.2018.05.005. PMID:30401422.
Tee KH, Seet LT, Tan WC, Choo HW. Advance directive: A study on the knowledge and attitudes among general practitioners in Singapore. Singapore Med J. 1997; 38:145-8.
Nedjat-Haiem FR, Cadet TJ, Amatya A, Mishra SI. Healthcare providers' attitudes, knowledge, and practice behaviors for educating patients about advance directives: A national survey. Am J Hosp Palliat Care. 2019; 36:387-95. doi:10.1177/1049909118813720. PMID:30486655.
Pereira-Salgado A, Mader P, O'Callaghan C, Boyd L, Staples M. Religious leaders' perceptions of advance care planning: A secondary analysis of interviews with Buddhist, Christian, Hindu, Islamic, Jewish, Sikh and Bahá'í leaders. BMC Palliat Care. 2017; 16:79. doi:10.1186/s12904-017-0239-3. PMID:29282112.
Wenger NS, Carmel S. Physicians' religiosity and end-of-life care attitudes and behaviors. Mt Sinai J Med. 2004; 71:335-43.
Al-Jahdali H, Baharoon S, Al Sayyari A, Al-Ahmad G. Advance medical directives: A proposed new approach and terminology from an Islamic perspective. Med Healthcare Philos. 2013; 16:163-9. doi:10.1007/s11019-012-9382-z. PMID:24571002.
Religion and advance medical directives: Formulation and enforcement implications [Internet]. 2016 Available from:.
Attitude ethics and communication (AETCOM) competencies for the Indian medical graduate [Internet]. 2018 Available from:.
Entry Date(s): Date Created: 20260604 Date Completed: 20260610 Latest Revision: 20260610
Update Code: 20260611
DOI: 10.25259/NMJI_817_2023
PMID: 42240506
Database: MEDLINE
Description
ISSN:2583-150X
DOI:10.25259/NMJI_817_2023