Willingness to develop an advance directive: perspectives of older persons at a national referral hospital in Uganda.

Abstract

Background: Understanding the treatment preferences of terminally ill patients is critical for the provision of quality care at the end of life. However, there is limited literature on the perspectives and willingness to develop advance directives among older persons in low-resource settings. This study explored the perspectives and willingness of older persons to develop an advance directive.

Methods: This was a qualitative study that involved older persons aged 60 years and over at a national referral hospital in Uganda. Data were collected through in-depth interviews and transcribed verbatim. Thematic analysis was performed, and the findings were reported using themes along with illustrative quotes from the participants.

Results: The study included 15 participants with an average age of 65.5 years (SD 4.4); most were male (10/15), married (12/15), and unemployed (10/15). Three themes were identified from the data, including: (1) understanding of advance directives, (2) perceptions about advance directives, and (3) willingness to develop advance directives. Most respondents had a limited understanding of advance directives. Advance directives were perceived as a foreign practice that was only applicable to the very sick and terminally ill. However, respondents were willing to develop advance directives for several reasons, including autonomy over one's health and the need to prevent family suffering and conflict in the event of death.

Conclusion: The study revealed a general lack of awareness and limited understanding of advance directives. There is a need for public sensitization on the importance of advance directives to healthcare practice and among older persons, given their high risk of morbidity and mortality due to aging. Promoting the use of advance directives in healthcare practice ethically recognizes one's autonomous rights of self-control.