Living Will Awareness and Collective Trust between Physicians, Cancer Patients and Caregivers: A Qualitative Study

Background: A living will is a form of Advance Directive (AD) that represents a patient’s wish, ensuring that their autonomy is respected and answered. However, after the Health Act Legislation in 2007, no practical assessment of living wills has been investigated in Thailand yet. Aim: To explore living will awareness and attitude in cancer patients and their family caregivers. Materials & Methods: Semi-structured interviews with purposive sampling method. Nine patients and five family caregivers at the Gyneoncology clinic from January 2014 to March 2014 joined the study. Three aspects were explored: awareness of and attitude towards living will, comprehension of medical terminology in the document, and decision-making. Data were coded and analysed using thematic analysis approach. Results: None of the participants have heard of living wills before. Three themes emerged: (1) Past experiences about death and terminal illness play a major role in perception of illness, comprehension of the document, and decision-making, (2) Participants’ decisions were based on mutual trust of their family members and their doctors, reflecting Thai collectivist culture, (3) Patients’ and caregivers’ perception of illness and autonomy need to be assessed. Conclusions: Larger scale assessment of living will awareness in Thailand is still needed. Perception of illness plays a major role regarding to AD and decision-making. Because of collective doctor-patient relationship, patients’ and caregivers’ perception of illness needs to be assessed before any AD is initiated. A joint meeting between family members and doctors is also a necessity, ensuring that the patient’s autonomy and the family’s concerns are thoroughly explored.