Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults.

(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = -0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.

Development and psychometric properties of the general public's attitudes toward advance care directives scale in Portugal.

Background: To date, no instrument in Portugal has evaluated the attitudes of the population about advance care directives. This paper describes the development and testing of the General Public's Attitudes Toward Advance Care Directives (GPATACD) Scale. Design and Methods: Methodological study. The development of the instrument was based on a literature review, updated in 2018. Face and content validity were verified by an expert panel and piloted among six participants. Data were collected in an online survey of 1024 Portuguese adults. The obtained data were analyzed using Varimax rotation, while the reliability was evaluated by calculating Cronbach's alpha. Results: The scale achieves good Item-Content Validity Index (I-CVI) values, between 0.89 and 1.00, and scale-CVI values of 0.91. A principal component analysis generated four dimensions with 26 items as a final scale, with overall Cronbach's alpha of 0.848. Conclusions: The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of the general public's attitudes toward advance care directives.

Atitudes da população portuguesa sobre as DAV / Attitudes of the Portuguese population about ADVs

O avanço científico e tecnológico interfere cada vez mais nos processos da morte. Nas situações clínicas em que não existem expectativas de recuperação, a pessoa maior de idade pode manifestar a sua vontade de recusar cuidados de saúde inúteis ou desproporcionados, com recurso às Diretivas Antecipadas de Vontade (DAV), legisladas em Portugal desde julho de 2012. Este trabalho teve como objetivo conhecer as atitudes da população portuguesa sobre as DAV e relacionar as atitudes com variáveis sociodemográficas, vivências de situações de morte e conhecimento sobre as DAV. Trata-se de um estudo quantitativo, descritivo, correlacional, com recurso a um questionário divulgado por via eletrónica. Este continha uma escala de atitudes sobre as DAV, que foi testada nas suas propriedades psicométricas. Fizeram parte da amostra 1024 indivíduos, na maioria mulheres, católicas e licenciadas, com uma média de idade de 40 anos e com formação na área da saúde. Grande parte já tinha passado por situações de morte de familiares ou amigos, mas apenas 1/3 vivenciou situações de cuidados paliativos. A maioria já tinha ouvido falar sobre as DAV, mas apenas 2,34% referem ter feito uma. No global as atitudes são favoráveis às DAV e o nível de conhecimentos é positivo. Há diferenças significativas nas atitudes face às DAV e o género, religião e formação relacionada com a saúde. A vivência de situações de familiares ou amigos em cuidados paliativos não foi determinante nas atitudes perante as DAV. Quanto maior o conhecimento, mais favoráveis as atitudes face às DAV. Os resultados relevam a necessidade de investir no aumento do conhecimento da população sobre as DAV.

Scientific and technological advances increasingly interfere with the processes of dying. In clinical situations in which there is no expectation of recovery, the person of legal age can express their will to refuse useless or disproportionate health care, using Advance Directives of Will (ADW), legislated in Portugal since July 2012. The aim of this study was to understand the attitudes of the Portuguese population towards Advance Directives and to relate these attitudes to sociodemographic variables, experiences of death and knowledge of Advance Directives. This was a quantitative, descriptive, correlational study using a questionnaire published electronically. The questionnaire contained a scale of attitudes towards AD, which was tested for its psychometric properties. The sample comprised 1024 individuals, mostly women, Catholic and university graduates, with an average age of 40 years and with a health background. Most of them had experienced the death of family members or friends, but only 1/3 had experienced palliative care. The majority had heard about ADV, but only 2.34% reported having done one. Overall, attitudes are favourable to ADC and the level of knowledge is positive. There are significant differences in attitudes towards AWD and gender, religion and health-related education. The experience of family members or friends in palliative care was not a determining factor in attitudes towards ADVs. The greater the knowledge, the more favourable the attitudes towards ADVs. The results highlight the need to invest in increasing the population's knowledge of AD.