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array:23 [ "pii" => "S0014256514002227" "issn" => "00142565" "doi" => "10.1016/j.rce.2014.05.008" "estado" => "S300" "fechaPublicacion" => "2014-08-01" "aid" => "971" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2014;214:311-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 599 "formatos" => array:2 [ "HTML" => 393 "PDF" => 206 ] ] "itemSiguiente" => array:18 [ "pii" => "S0014256514002276" "issn" => "00142565" "doi" => "10.1016/j.rce.2014.05.013" "estado" => "S300" "fechaPublicacion" => "2014-08-01" "aid" => "976" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2014;214:313-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 828 "formatos" => array:2 [ "HTML" => 314 "PDF" => 514 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Sarcopenia: A condition in need for identification in different health care settings" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "314" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcopenia: una condición que debe identificarse en los diferentes ámbitos asistenciales" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H.P. Patel" "autores" => array:1 [ 0 => array:2 [ "nombre" => "H.P." "apellidos" => "Patel" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002276?idApp=WRCEE" "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002276/v1_201407221202/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0014256514002264" "issn" => "00142565" "doi" => "10.1016/j.rce.2014.05.012" "estado" => "S300" "fechaPublicacion" => "2014-08-01" "aid" => "975" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2014;214:309-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 848 "formatos" => array:2 [ "HTML" => 489 "PDF" => 359 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Diagnóstico de la fibrosis quística en el adulto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "310" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnostic of cystic fibrosis in adult" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. de Gracia, A. Álvarez Fernández" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "de Gracia" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Álvarez Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002264?idApp=WRCEE" "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002264/v1_201407221202/es/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Advance directives: Better than nothing at all" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M.J. Silveira" "autores" => array:1 [ 0 => array:4 [ "nombre" => "M.J." "apellidos" => "Silveira" "email" => array:1 [ 0 => "mariajs@med.umich.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Research Scientist Center for Clinical Management Research, Ann Arbor Veterans Administration Medical Center, Michigan, United States" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, University of Michigan, United States" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Directivas médicas por adelantado: esta opción mejor que ninguna" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Revista Clínica Española</span>, Antolin et al. have shown that despite having one of the highest advance directive completion rates in Spain, patients in Catalonia rarely bring their advance directives to the hospital where they can be of use to their physicians.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over the course of a decade, only 130 advance directives were registered at the tertiary care center where the study was conducted. The major limitation of the study is that we do not know how many people completed an advance directive and never registered it; thus, from this study we cannot determine what the true advance directive completion rate is in Catalonia. Still, the data raise two common concerns with regards to advance directives: (1) people do not complete them and (2) advance directives are not shared with healthcare providers.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Indeed, when similar studies from the 1990s showed that few Americans completed advance directives, advance directives were unavailable to physicians when necessary, few patients discussed the contents of their advance directives with their personal physician,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and few physicians asked patients about their advance directives,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> some argued that the US should forgo advance directives altogether.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Fortunately, advances over the years have led us to a place where these factors are no longer applicable in the US.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the United States, we have seen the percentage of elderly community dwelling adults with an advance directive climb from 47% in 2000 to 72% in 2010.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A number of legal, financial, and cultural factors are likely to explain the change. First, the United States has had a law in place since 1990 (the Patient Self Determination Act<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>) mandating that every hospital in the nation inform patients of their right to compose an advance directive. Second, physicians have found ways to be reimbursed by Medicare (the nation's primary insurance for the aged) for time spent in advance care planning. Currently, there is a bill under consideration by Congress to incentivize patients financially to complete advance directives.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Third, as the Baby Boomer generation ages, caregiving for demented elderly has become increasingly common and burdensome, diminishing the specter around planning for death. The term “advance directive” is familiar to most people, especially those over age 60. Lastly, there is growing and convincing evidence of the benefits of advance directives<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and advance care planning.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">What we learned from our experience in the US is that low advance directive completion and documentation rates are not a marker of outright failure of the advance directive, but rather a symptom of an inadequate process that needs amelioration. Thus, I believe the major implication of Antolin's study is that Catalonia needs a better process to systematically encourage patients to complete advance directives and ensure that completed advance directives are disseminated and readily discoverable when necessary. There are communities that Catalonia can turn to for guidance.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One such community is LaCrosse Wisconsin where a group of healthcare organizations worked in collaboration to develop and implement a system to: (1) ask all adults to reflect on and discuss their future care in the event of a serious illness; (2) ask all adults to document their preferences in writing; (3) ensure that written care plans (including advance directives) are electronically stored, transferred, and retrieved wherever a patient gets care; and (4) ensure that written care plans are reviewed and honored when necessary.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Data suggest 85% of decedent residents of LaCrosse have advance directive and 95% of these advance directives are available through the electronic medical record at the time of death.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Among those with an advance directive, 98% receive care consistent with their preferences.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Some might argue that even with a system like LaCrosse's in place, Catalonia might never achieve the same rate of adoption of advance directives. It is true that advance directives are an American invention and a product of a Western philosophy respecting personal autonomy above all else and valuing individual over social good. The culture of Catalonia is different than the culture of the US. Indeed, when we examine the uptake of advance directives among ethnic minorities in the US (including Latin-Americans), rates of advance directive completion are very low.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> While there are some things we can do to make advance directives more appealing to diverse cultures, there may be patients for whom an advance directive will never acceptable (e.g. when they are superstitious about discussing death or when they believe in family-centered decision making over decision making by the patient alone) and that should be okay.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Even if we cannot get 100% of the population to engage in advance care planning or to document their preferences in an advance directive, we should still keep trying. If not because it is the “right thing to do,” then for one simple reason: Advance directives come into effect when a patient loses decisional capacity and evidence shows that this happens more often than one would think. Antolin et al. found that among patients who completed advance directives in Catalonia, over 30% lost their decisional capacity before death.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the United States, the number is closer to 60% among community dwelling elderly. As long as modern medicine continues to successfully prolong life without concurrently knowing how to preserve and protect decisional capacity, decision making for patients who cannot speak for themselves will continue to challenge us. While many families are able to step in for their incapacitated family members, though that is not always the case, and an advance directive will always be better than nothing at all.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and use of advanced directives in a tertiary hospital. Period 2001–2011" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Antolin" 1 => "S. Jimenez" 2 => "M. Gonzalez" 3 => "E. Gomez" 4 => "M. Sanchez" 5 => "O. 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Haley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gerontologist" "fecha" => "2005" "volumen" => "45" "paginaInicial" => "634" "paginaFinal" => "641" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16199398" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.assets" "Apartado" => array:4 [ "identificador" => "1020" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editoriales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002227?idApp=WRCEE" ]
