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Planning for End-of-Life Care: Findings from the Canadian Study of Health and Aging*

  • Douglas D. Garrett (a1) (a2), Holly Tuokko (a3), Kelli I. Stajduhar (a3), Joan Lindsay (a4) and Sharon Buehler (a5)...

Abstract

Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants had thought about, discussed, or formalized their end-of-life preferences), and considered, as well, whether relations existed among the three outcomes. Canadian region of residence, female gender, and more years of education predicted having thought about preferences; region of residence, female gender, and lack of cognitive impairment predicted discussion of preferences; and region of residence and not being married predicted whether formal documents were in place. Ontario residents were most likely to have thought about, discussed, and formalized their preferences, whereas Atlantic residents were least likely to. Finally, having thought about preferences was associated with discussion, and having thought about and having discussed preferences were each associated with formalization of preferences. These findings are in keeping with the position that Advance Directives (AD) execution is a multi-stage process. A better understanding of this process may prove useful for the development of interventions to promote planning for end-of-life care.

Les étapes utilisées pour l'officialisation des préférences en matière de soins en fin de vie et les facteurs en rapport avec ces étapes sont flous dans la documentation. À l'aide des données de la troisième phase de l'Étude sur la santé et le vieillissement au Canada (ESVC-3), nous avons examiné les relations entre les prédicteurs démographiques et en matière de santé, et les trois résultats (à savoir si les participants avaient réfléchi à leurs préférences de fin de vie, s'ils en avaient discuté, ou s'ils les avaient officialisées), et s'il y avait des relations entre les trois résultats. La région de résidence au Canada, le sexe féminin, et davantage d'années de scolarité étaient des facteurs associés à des personnes ayant réfléchi à leurs préférences. La région de résidence, le sexe féminin, et le manque de déficience cognitive étaient associés aux discussions en matière de préférences, et la région de résidence et le fait de ne pas avoir de conjoint étaient associés au dépôt de documents officiels. Les résidents de l'Ontario étaient les plus enclins à avoir réfléchi à leurs préférences, à en avoir discuté, et à les avoir officialisées, tandis que les résidents des Maritimes étaient les moins enclins à y avoir pensé et à avoir agi en conséquence. Enfin, avoir réfléchi à leurs préférences était associé au fait d'en discuter, et y avoir réfléchi et en avoir discuté étaient chacun associés à l'officialisation des préférences. Ces résultats correspondent au postulat que l'exécution du mandat (directive par procuration) est un processus comportant plusieurs étapes. Avoir une meilleure idée de ce processus peut se révéler utile lors de l'élaboration d'interventions visant à promouvoir la planification des soins en fin de vie.

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Corresponding author

Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Holly A. Tuokko, Ph.D., RPsych., Professor, Centre on Aging, Sedgewick Building Room A104, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, (htuokko@uvic.ca)

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*

Phases 1 and 2 of the Canadian Study of Health and Aging core study were funded by the Seniors' Independence Research Program, through Health Canada's National Health Research and Development Program (NHRDP project #6606-3954-MC(S)); supplementary funding for analysis of the caregiver component was provided by the Medical Research Council. Additional funding was provided by Pfizer Canada Incorporated, through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project #6603-1417-302(R)), by Bayer Incorporated, and by the British Columbia Health Research Foundation (projects #38 (93-2) and #34 (96-1)). Core funding for Phase 3 was obtained from the Canadian Institutes for Health Research (CIHR grant #MOP-42530); supplementary funding for the caregiver component was obtained from CIHR grant #MOP-43945. Additional funding was provided by Merck-Frosst and by Janssen-Ortho, Inc. The study was coordinated through the University of Ottawa and Health Canada. Douglas D. Garrett is supported by a graduate scholarship from the Natural Science and Engineering Research Council of Canada and the Annie Kishenblatt Award in Gerontology from the Toronto Rehabilitation Institute. A research personnel award from the Canadian Institutes of Health Research, Institute of Aging (Senior Investigator Award) supported Dr. Tuokko in the preparation of this manuscript. At the time of this investigation, Dr. Stajduhar was supported with post-doctoral funding from the Canadian Institutes of Health Research (CIHR) and the Michael Smith Foundation for Health Research (MSFHR). Currently, Dr. Stajduhar is supported by a New Investigator Award from the Canadian Institutes for Health Research and a Scholar Award from the Michael Smith Foundation for Health Research.

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References

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Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
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