Living Will Completion During Palliative Care Consultations and Factors Influencing Completion: A Retrospective Study in a University Hospital

OBJECTIVE To determine the proportion of palliative care patients completing a living will and to identify factors associated with completion. METHODS This retrospective study analyzed electronic medical records from Maharaj Nakorn Chiang Mai Hospital, a university hospital in Thailand. Patients who had their initial palliative care consultations between November 1, 2021 and April 30, 2022 were included. Descriptive statistics and multivariable logistic regression were used. RESULTS Of the 389 patients in the study, 205 (52.7%) were female, and the median age was 68 (IQR: 59–79). Most had cancer (67.6%) and poor performance status (PPS 10–30: 69.9%). Decision-making capacity was present in 177 patients (45.5%). A living will was introduced to 83 patients (21.3%) and was completed by 26 (6.7%). Higher PPS (70–100) was associated with being introduced to a living will. The most common reason for not introducing patients to a living will was poor patient symptom control. No factors were significantly associated with living will completion among those who were introduced to a living will. CONCLUSIONS Most patients presented to palliative care with advanced disease and poor performance status, limiting opportunities for living will discussions and emphasizing the need for early consultation. Strengthening symptom management may support earlier and more frequent introduction of a living will, potentially improving completion rates.