Surrogate decision-maker for end-of-life care in terminally ill patients at Chiang Mai University Hospital, Thailand.

Surrogate decision-maker for end-of-life care is indicated at certain points during care for patients with terminal illnesses. This study aimed at identifying person(s) to whom northern Thai patients with terminal illnesses wished to transfer their decisions on end-of-life care and for cardiopulmonary resuscitation. From interviews with 152 eligible subjects, 57.2% had a high regard for their physicians' authority in making decisions on end-of-life care, 28.3% transferred their decisions to relative(s) and only 14.5% opted for shared decision-making among relative(s) and physicians. In the provision of cardiopulmonary resuscitation, 44.1% of subjects expressed a desire for family to make decisions together with physicians, 33.6% gave directives to the family alone and only 22.4% transferred their decisions to physicians. The differences that were observed in patients' preferences between the two situations indicate that patients should be assessed individually and adequate information for decision-making should be provided.

Physicians' attitudes and practices regarding advanced end-of-life care planning for terminally ill patients at Chiang Mai University Hospital, Thailand.

This study examined physicians' attitudes toward advanced directives and practices for the end-of-life care at Chiang Mai University Hospital, Thailand. The data were collected from 55 physicians (24 instructors and 31 residents) using self-reported questionnaires. The majority of the participants affirmed the usefulness of the advance directive (AD) for cardiopulmonary resuscitation and respected the patients' wish for this directive, although advanced end-of-life care and resuscitation planning with the patients was limited. Mostly, the relatives were consulted regarding ADs. This study suggests that, in traditional Thai culture, physicians and families are more inclined to make decisions for the patient when they feel that it is in the patient's best interest. Further research is needed to investigate how and to what extent such attitudes can affect medical practice for end-of-life care in the context of the rapid development and consequent changes taking place in Thailand.

Effectiveness of advance directives for the care of terminally ill patients in Chiang Mai University Hospital, Thailand.

The key hypothesis behind advance directives (ADs) proposes that, if an intervention enhances a person's right to choose, a dying person will not opt for expensive, life-prolonging medical care and an ethically acceptable saving of resources will result. In order to assess the acceptability and effectiveness of ADs in reducing cardiopulmonary resuscitation (CPR) attempts and in-hospital death among terminally ill patients in a tertiary care hospital in northern Thailand, a non-randomized, controlled intervention study using an after-only unequivalent control group design was conducted. The majority of the subjects and the surrogates preferred to employ ADs in expressing their preferences on CPR and there was a high level of agreement between the subjects and surrogates on the decision. The use of ADs appeared to be effective in reducing futile CPR attempts and the in-hospital mortality rate among subjects during the index hospitalization. Advance directives were accepted well in this study setting.

Attitudes toward advance directives and the impact of prognostic information on the preference for cardiopulmonary resuscitation in medical inpatients in Chiang Mai University Hospital, Thailand.

Our previous study revealed that cardiopulmonary resuscitation (CPR) was performed in 65.7% of 411 terminally ill patients who died in a tertiary-care university hospital in northern Thailand. Advance directives (ADs) are needed to ensure that life-sustaining therapies are used more appropriately. To investigate inpatients' attitudes regarding ADs for CPR and the impact of providing prognostic information on treatment preferences for CPR, we interviewed a randomly selected group of 200 ambulatory medical inpatients in multiple sessions. The results showed that most subjects had a positive attitude towards ADs for CPR. The majority preferred to have CPR when no information was provided on the chance of survival. However, this proportion decreased depending on the prognostic scenarios. Our investigation suggested that the preference of patients for CPR should be assessed individually and gradually, with adequate information given on the chance of survival.