Attitudes and knowledge relating to advance healthcare directives among medical and surgical inpatients and healthcare staff in Ireland

Advance healthcare directives (AHDs) are commonly discussed as a way to enhance patient autonomy but are rarely used, often owing to lack of awareness. This study aimed to assess knowledge of, and attitudes towards, AHDs in hospital inpatients and staff in Ireland one year after a new system of AHDs was introduced into law. We surveyed knowledge of and attitudes towards AHDs among 120 inpatients and 102 staff at a Dublin hospital. No patient had made an AHD and few had heard of them (11.7%), but two thirds (65.8%) would make an AHD if supported by their healthcare provider, most commonly requesting specific treatments (70.0%) and place of care (62.5%). Majorities felt that somebody else should be involved in writing the AHD (96.7%) and that healthcare professionals would respect AHDs (85.0%). Future willingness to make an AHD was associated with younger age and greater education. A majority (80.4%) of staff members had heard of AHDs and almost half (45.1%) had cared for a patient with one. Vast majorities felt that AHDs were a good idea (97.1%), especially those who had cared for a patient with an AHD. Majorities of staff (84.3%) and patients (61.7%) would prefer an advance care plan that was not legally binding but included the patient’s will and preferences. There is a need for greater education about AHDs, but also respect for the preference of both patients and staff for advance care plans that are not legally binding but include the patient’s will and preferences.