Perception of advance directive in Thai women with cancer: a qualitative study

Tharin Phenwan


Advance Directive (AD) is a medical agreement to ensure that patients’ autonomy is respected. In Thailand, there has been Health Act Legislation to promote the use of a living will, a form of AD, since 2007. However, there is no assessment of its practicability yet. The objective of this study was to explore perceptions and attitudes to living wills by women who were diagnosed with cancer. We conducted semi-structured interview with purposive sampling method. Fifteen patients at the gynaecologic oncology clinic from January 2014 to April 2015 joined the study. Participants were instructed to read the living will document designed by the Thai National Health Security Office (NHSO) and asked about three aspects; awareness of and attitude towards living wills, comprehension of the document, and decision-making. Final codes were analysed using investigator and data triangulation methods along with content analysis. All patcipants were in the early stages of cancer. Five women were diagnosed with breast cancer, seven with cervical cancer, and three with ovarian cancer. None of them had heard of living wills before. Three themes emerged; 1) Participants felt overwhelmingly positive about the idea of making an AD with a living will. 2) The document was too complicated for participants. 3) Past experiences about death and terminal illness played a major role in decision-making regarding AD. In conclusion, larger scale assessment of AD in Thailand is recommended. And living wills prove to be a useful tool for making AD in women with cancer but need to be simplified.


Advance Directive, Living will, Qualitative research, Cancer, Palliative Care


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Last updated: 13 February 2019