Alexander K Leung1, Dhruv Nayyar2, Manisha Sachdeva2, John Song3, Stephen W Hwang4. 1. Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada alexander.kh.leung@gmail.com. 2. Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. 3. Center for Bioethics, University of Minnesota, Minneapolis, MN, USA. 4. Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Chronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives. AIM: To determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completion, and describe end-of-life care preferences in a group of chronically homeless individuals. DESIGN: Participants completed a survey and were offered an opportunity to complete an advance directive with a trained counselor. PARTICIPANTS: A total of 205 residents of a shelter in Canada for homeless men (89.1% of those approached) participated from April to June 2013. RESULTS: Duration of homelessness was ⩾12 months in 72.8% of participants, and 103 participants (50.2%) chose to complete an advance directive. Socio-demographic characteristics, health status, and health care use were not associated with completion of an advance directive. Participants were more likely to complete an advance directive if they reported thinking about death on a daily basis, believed that thinking about their friends and family was important, or reported knowing their wishes for end-of-life care but not having told anyone about these wishes. Among individuals who completed an advance directive, 61.2% named a substitute decision maker, and 94.1% expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest if there was a chance of returning to their current state of health. CONCLUSION: A counselor-guided intervention can achieve a high rate of advance directive completion among chronically homeless persons. Most participants expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest.
BACKGROUND: Chronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives. AIM: To determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completion, and describe end-of-life care preferences in a group of chronically homeless individuals. DESIGN:Participants completed a survey and were offered an opportunity to complete an advance directive with a trained counselor. PARTICIPANTS: A total of 205 residents of a shelter in Canada for homeless men (89.1% of those approached) participated from April to June 2013. RESULTS: Duration of homelessness was ⩾12 months in 72.8% of participants, and 103 participants (50.2%) chose to complete an advance directive. Socio-demographic characteristics, health status, and health care use were not associated with completion of an advance directive. Participants were more likely to complete an advance directive if they reported thinking about death on a daily basis, believed that thinking about their friends and family was important, or reported knowing their wishes for end-of-life care but not having told anyone about these wishes. Among individuals who completed an advance directive, 61.2% named a substitute decision maker, and 94.1% expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest if there was a chance of returning to their current state of health. CONCLUSION: A counselor-guided intervention can achieve a high rate of advance directive completion among chronically homeless persons. Most participants expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest.
Authors: Alexander K Leung; Matthew J To; Linh Luong; Zahra Syavash Vahabi; Victor L Gonçalves; John Song; Stephen W Hwang Journal: J Urban Health Date: 2017-02 Impact factor: 3.671
Authors: Briony F Hudson; Caroline Shulman; Joseph Low; Nigel Hewett; Julian Daley; Sarah Davis; Nimah Brophy; Diana Howard; Bella Vivat; Peter Kennedy; Patrick Stone Journal: BMJ Open Date: 2017-11-28 Impact factor: 2.692
Authors: Caroline Shulman; Briony F Hudson; Joseph Low; Nigel Hewett; Julian Daley; Peter Kennedy; Sarah Davis; Niamh Brophy; Diana Howard; Bella Vivat; Patrick Stone Journal: Palliat Med Date: 2017-07-03 Impact factor: 4.762
Authors: Hanna T Klop; Anke J E de Veer; Sophie I van Dongen; Anneke L Francke; Judith A C Rietjens; Bregje D Onwuteaka-Philipsen Journal: BMC Palliat Care Date: 2018-04-24 Impact factor: 3.234