Living Will: A Cross-Sectional Study on the Perspective, Knowledge, and Clinical Use of General Practitioners in Portugal

Abstract

Rationale

In Portugal, living wills—legal documents allowing individuals to express healthcare preferences in case of future incapacity—have been recognized since 2012. Despite this, public engagement remains limited, and previous studies have highlighted both public unawareness and knowledge gaps among healthcare professionals.

Aims and Objectives

This study aimed to assess the perspectives, knowledge, and clinical use of living will among Portuguese General Practitioners (GPs), given their pivotal role in promoting health literacy and patient autonomy.

Methods

A cross-sectional, quantitative survey was conducted among Portuguese GPs, using a 30-item online questionnaire that covered demographics, knowledge, attitudes, and clinical practices. Non-parametric statistical analyses, including Spearman correlation and the Mann-Whitney test, were used to assess associations.

Results

A total of 392 GPs answered the questionnaire, with a median age of 35 years. In their clinical practice, almost half of healthcare professionals have had conversations with their patients about Advance Directives (ADs), although 22.3% were unable to locate a living will in the Portuguese Public Healthcare Service Electronic System. The median number of correct answers to the 14 questions that require knowledge about the Portuguese law of ADs was 10, with a minimum of 5 and a maximum of 14. Most doctors reported that fewer than 1% of their patients have inquired about ADs.

Conclusions

Despite recognizing the importance of living wills, GPs seldom address them in consultations, often due to limited knowledge and practical barriers. Findings underscore the need for targeted training and public awareness initiatives to promote advanced care planning in primary care settings.