Advance directives in palliative care: how do they affect patients’ hope?

Healthcare teams avoid discussing Advance Directives, fearing the discussion will disrupt the patient’s hope. However, hope helps palliative patients cope with illness and improve their physical and spiritual well-being. This paper analyzes how inclusion in an Advance Directive trial (DAVPAL Study) affected patients’ hope. Patients were asked to fill out their Advance Directives and the Herth Hope Index questionnaire before allocation to the Intervention or Control groups of the DAVPAL study. In the Intervention group, the doctor promoted a discussion of the patient’s Advance Directives with their nominated surrogates. In the Control Group, the doctor only accessed the patient’s symptoms. After both interventions, patients filled out another Herth Hope Index questionnaire. The sociodemographic characteristics of the patients allocated to the Intervention and Control groups (29 patients each) were similar. We analyzed the patients’ hope in both groups before and after the trial and observed an improvement in the patients’ hope in the two groups. However, the Intervention group achieved more significant results. Completing the Advance Directives improved the palliative patients’ hope, but discussing the content of these documents was associated with more significant results. Future research should analyze and compare the effect of the Advance Directives discussion on patients’ hope versus usual care consultations.

Trial registration: ClinicalTrials.gov ID NCT05090072. Retrospectively registered on 22/10/2021. https://clinicaltrials.gov/ct2/show/NCT05090072?term=NCT05090072&cond=Advance+Directives&draw=2&rank=1