Characteristics associated with the intention to complete advance directives and end-of-life preferences in Brazilians with heart failure

OBJECTIVE: To identify characteristics associated with an intention to complete advance directives (ADs) and end-of-life treatment preferences for outpatients with heart failure (HF). METHODS: A cross-sectional, analytical study. Sociodemographic and clinical data were collected from 108 patients with HF in an outpatient clinic in São Paulo, SP, Brazil. Quality of life (QoL) was assessed using the Minnesota Living with Heart Failure Questionnaire; knowledge about HF and the intention to complete ADs were assessed using a script. The relationships among variables were assessed through the chi-square and Mann-Whitney tests, with p < 0.05 considered significant. RESULTS: The intention to complete ADs was significantly associated with reporting adherence to pharmacological recommendations (99% vs. 88.1%, p = 0.02), worse QoL (29.7 ± 18.2 vs. 20.9 ± 11.0; p = 0.0336), perceived knowledge about HF (89.7% vs. 63.6%, p = 0.0495), not wishing the healthcare providers would decide about treatment (27.3% vs. 2.15, p = 0.0026), and considering ADs useful (91.8% vs. 27.3%, p < 0.001). End-of-life treatment preferences included living as long as possible (50.5%), not being sedated (37.1%), and staying close to family and friends for as long as possible (32.0%). CONCLUSIONS: Characteristics associated with an intention to complete ADs and end-of-life treatment preferences were identified in patients with HF.

Characteristics associated with the intention to complete advance directives and end-of-life preferences in Brazilians with heart failure.

OBJECTIVE: To identify characteristics associated with an intention to complete advance directives (ADs) and end-of-life treatment preferences for outpatients with heart failure (HF). METHODS: A cross-sectional, analytical study. Sociodemographic and clinical data were collected from 108 patients with HF in an outpatient clinic in São Paulo, SP, Brazil. Quality of life (QoL) was assessed using the Minnesota Living with Heart Failure Questionnaire; knowledge about HF and the intention to complete ADs were assessed using a script. The relationships among variables were assessed through the chi-square and Mann-Whitney tests, with p < 0.05 considered significant. RESULTS: The intention to complete ADs was significantly associated with reporting adherence to pharmacological recommendations (99% vs. 88.1%, p = 0.02), worse QoL (29.7 ± 18.2 vs. 20.9 ± 11.0; p = 0.0336), perceived knowledge about HF (89.7% vs. 63.6%, p = 0.0495), not wishing the healthcare providers would decide about treatment (27.3% vs. 2.15, p = 0.0026), and considering ADs useful (91.8% vs. 27.3%, p < 0.001). End-of-life treatment preferences included living as long as possible (50.5%), not being sedated (37.1%), and staying close to family and friends for as long as possible (32.0%). CONCLUSIONS: Characteristics associated with an intention to complete ADs and end-of-life treatment preferences were identified in patients with HF. IMPLICATIONS FOR NURSING PRACTICE: These results can help facilitate patients' completion of their ADs or activate their intention to maximize opportunities to exercise autonomy.

OBJETIVO: Identificar características associadas à intenção de completar diretivas antecipadas de vontade (DAV) e preferências de tratamento no final da vida de pacientes ambulatoriais com insuficiência cardíaca (IC). MÉTODOS: Estudo analítico, transversal. Foram coletados dados sociodemográficos e clínicos de 108 pacientes com IC atendidos em um ambulatório de São Paulo­SP, Brasil. A qualidade de vida (QV) foi avaliada por meio do Minnesota Living with Heart Failure Questionnaire, o conhecimento sobre IC e a intenção de completar as DAV foram avaliados por meio de um roteiro. As relações entre as variáveis foram avaliadas por meio dos testes qui­quadrado e Mann­Whitney, sendo considerado significativo p < 0,05. RESULTADOS: A intenção de completar as DAV foi significativamente associada ao relato de adesão às recomendações farmacológicas (99% vs 88,1%, p = 0,02), pior QV (29,7 ± 18,2 vs 20,9 ± 11,0; p = 0,0336), conhecimento percebido sobre IC (89,7% vs 63,6%, p = 0,0495), não desejar que os profissionais de saúde decidissem sobre o tratamento (27,3% vs 2,15, p = 0,0026) e considerar as DAV úteis (91,8% vs 27,3%, p < 0,001). As preferências de tratamento no final da vida incluíam viver o maior tempo possível (50,5%), não ser sedado (37,1%) e permanecer perto da família e amigos o maior tempo possível (32,0%). CONCLUSÕES: Foram identificadas características associadas à intenção de completar DAV e preferências de tratamento no final da vida em pacientes com IC. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Estes resultados podem ajudar a facilitar a conclusão das suas DAV pelos pacientes ou ativar a sua intenção de maximizar as oportunidades de exercício da autonomia.