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Med Intensiva. 2016 Apr;40(3):154-62. doi: 10.1016/j.medin.2015.04.011. Epub 2015 Jun 10.

Advance directives in intensive care: Health professional competences.

[Article in English, Spanish]

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Servicio de Medicina Intensiva, Hospital Clínico San Carlos , Madrid, España; Universidad Complutense de Madrid, Madrid, España. Electronic address:
Universidad Complutense de Madrid, Madrid, España.



To identify knowledge, skills and attitudes among physicians and nurses of adults' intensive care units (ICUs), referred to advance directives or living wills.


A cross-sectional descriptive study was carried out.


Nine hospitals in the Community of Madrid (Spain).


Physicians and nurses of adults' intensive care.


A qualitative Likert-type scale and multiple response survey were made.


Knowledge, skills and attitudes about the advance directives. A descriptive statistical analysis based on percentages was made, with application of the chi-squared test for comparisons, accepting p < 0.05 as representing statistical significance.


A total of 331 surveys were collected (51%). It was seen that 90.3% did not know all the measures envisaged by the advance directives. In turn, 50.2% claimed that the living wills are not respected, and 82.8% believed advance directives to be a useful tool for health professionals in the decision making process. A total of 85.3% the physicians stated that they would respect a living will, in cases of emergencies, compared to 66.2% of the nursing staff (p = 0.007). Lastly, only 19.1% of the physicians and 2.3% of the nursing staff knew whether their patients had advance directives (p < 0.001).


Although health professionals displayed poor knowledge of advance directives, they had a favorable attitude toward their usefulness. However, most did not know whether their patients had a living will, and some professionals even failed to respect such instructions despite knowledge of the existence of advance directives. Improvements in health professional education in this field are needed.


Advance directives; Cuidados al final de la vida; Cuidados intensivos; End of life care; Instrucciones previas; Intensive care; Living wills; Testamento vital; Voluntades anticipadas

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