{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T15:18:25Z","timestamp":1761664705629},"reference-count":83,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T00:00:00Z","timestamp":1712102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Ethics"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Advance directives (ADs) were implemented in Portugal in 2012. Although more than a decade has passed since Law 25\/2012 came into force, Portuguese people have very low levels of adherence. In this context, this study aimed to identify and analyse the attitudes of people aged 18 or older living in Portugal towards ADs and to determine the relationships between sociodemographic variables (gender\/marital status\/religion\/level of education\/residence\/whether they were a health professional\/whether they had already drawn up a living will) and people\u2019s attitudes towards ADs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>An online cross-sectional analytical study was conducted using a convenience sample. For this purpose, a request (email) that publicized the link to a \u2013form\u2014which included sociodemographic data and the General Public Attitudes Toward Advance Care Directives (GPATACD) scale\u2014was sent to 28 higher education institutions and 30 senior universities, covering all of mainland Portugal and the islands (Azores and Madeira). The data were collected between January and February 2023.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 950 adults from completed the online form. The lower scores (mean 1 and 2) obtained in most responses by applying the GPATACD scale show that the sample of the Portuguese population has a very positive attitude towards ADs. The data showed that women, agnostics\/atheists, health professionals and those who had already made a living will had more positive attitudes (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) towards ADs. There were no statistically significant differences in the attitudes of the Portuguese population sample towards ADs in relation to marital status, education level, and residence.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The results obtained enable us to confirm that this sample of the Portuguese population has a positive attitude towards ADs. We verify that there are certain fringes of this sample with certain sociodemographic characteristics (women, agnostics\/atheists, health professionals and those who had already made a living will) that have a more positive attitude towards ADs. This data could facilitate the implementation and adjustment of relevant measures, particularly in the field of health education and aimed at groups with less favourable attitudes, to increase the effectiveness of voluntary exercise of citizens\u2019 autonomy in end-of-life care planning.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12910-024-01043-x","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T10:01:38Z","timestamp":1712138498000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Attitudes of the Portuguese population towards advance directives: an online survey"],"prefix":"10.1186","volume":"25","author":[{"given":"Jo\u00e3o Carlos","family":"Macedo","sequence":"first","affiliation":[]},{"given":"Lu\u00edsa","family":"Castro","sequence":"additional","affiliation":[]},{"given":"Rui","family":"Nunes","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,4,3]]},"reference":[{"key":"1043_CR1","doi-asserted-by":"publisher","unstructured":"Manda-Taylor L, Masiye F, Mfutso-Bengo J. Autonomy. In: Have H ten, editor. Encyclopedia of Global Bioethics [Internet]. Cham: Springer International Publishing; 2016. pp. 218\u201325. https:\/\/link.springer.com\/https:\/\/doi.org\/10.1007\/978-3-319-09483-0_460.","DOI":"10.1007\/978-3-319-09483-0_460"},{"key":"1043_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-00976-2","volume-title":"Advance directives: rethinking regulation, autonomy & Healthcare decision-making","author":"HY Chan","year":"2018","unstructured":"Chan HY. Advance directives: rethinking regulation, autonomy & Healthcare decision-making. Cham: Springer International Publishing; 2018."},{"key":"1043_CR3","unstructured":"Nunes R, Bio\u00e9tica, Bras\u00edlia. Conselho Federal de Medicina\/ Faculdade de Medicina da Universidade do Porto; 2022."},{"key":"1043_CR4","unstructured":"Santos LF. Testamento Vital - O que \u00e9? Como elabor\u00e1-lo? Sextante Editora. Porto; 2011."},{"key":"1043_CR5","doi-asserted-by":"crossref","unstructured":"Andorno R, Biller-Andorno N, Brauer S, Biller-Andorno N. Advance health care directives: Towards a coordinated European policy? Eur J Health Law [Internet]. 2009 [cited 2021 Apr 27];16:207\u201327. https:\/\/brill.com\/view\/journals\/ejhl\/16\/3\/article-p207_2.xml.","DOI":"10.1163\/157180909X453053"},{"key":"1043_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/esmoopen-2020-000953","volume":"5","author":"D Martins-Branco","year":"2020","unstructured":"Martins-Branco D, Lopes S, Canario R, Freire J, Feio M, Ferraz-Goncalves J, et al. Factors associated with the aggressiveness of care at the end of life for patients with cancer dying in hospital: a nationwide retrospective cohort study in mainland Portugal. ESMO Open. 2020;5:1\u201310.","journal-title":"ESMO Open"},{"key":"1043_CR7","doi-asserted-by":"publisher","DOI":"10.1142\/9781848169999_0003","volume-title":"The reality of medical futility (Dysthanasia) in Brazil","author":"L Pessini","year":"2013","unstructured":"Pessini L, Hossne WS. The reality of medical futility (Dysthanasia) in Brazil. Medical Futility: A Cross-National Study; 2013."},{"key":"1043_CR8","first-page":"15","volume":"19","author":"A Goreti","year":"2011","unstructured":"Goreti A, Feio O, Oliveira CC. Responsibility and technology: the issue of dysthanasia. Rev Bioet. 2011;19:15\u201330.","journal-title":"Rev Bioet"},{"key":"1043_CR9","doi-asserted-by":"crossref","unstructured":"Macedo JC. Bioethics Reflection on Life Prolongation in End-of-Life Care. International Journal of Clinical Studies & Medical Case Reports [Internet]. 2022 [cited 2023 Aug 25];17:e1\u20134. https:\/\/ijclinmedcasereports.com\/ijcmcr-rw-id-00411\/.","DOI":"10.46998\/IJCMCR.2022.17.000411"},{"key":"1043_CR10","unstructured":"Benzenh\u00f6fer U, Hack-Molitor G. Luis Kutner and the development of the advance directive (living will) [Internet]. Benzeenh\u00f6fer O, editor. Wetzlar; 2009 [cited 2023 Sep 3]. http:\/\/publikationen.ub.uni-frankfurt.de\/frontdoor\/index\/index\/docId\/34515."},{"key":"1043_CR11","unstructured":"Kutner L. Euthanasia: due process for death with dignity; the living will. Indiana Law Journal [Internet]. 1969;44:539\u201354. http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11664995."},{"key":"1043_CR12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/978-94-007-7377-6_1","volume-title":"Advance directives","author":"A Simon","year":"2014","unstructured":"Simon A. Historical Review of Advance directives. In: Lack P, Biller-Andorno N, Brauer S, editors. Advance directives. New York\/London: Springer; 2014. pp. 3\u201316."},{"key":"1043_CR13","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1163\/15718093-12341368","volume":"22","author":"D Veshi","year":"2015","unstructured":"Veshi D, Neitzke G. Advance directives in some western European countries: a legal and ethical comparison. Eur J Health Laww. 2015;22:321\u201345.","journal-title":"Eur J Health Laww"},{"key":"1043_CR14","unstructured":"Nunes R. Directivas Anticipadas de Voluntad [Internet]. Bras\u00edlia: Consejo Federal de Medicina; 2020. http:\/\/portal.cfm.org.br\/."},{"key":"1043_CR15","volume-title":"Testamento Vital","author":"R Nunes","year":"2011","unstructured":"Nunes R, Melo HP. Testamento Vital. Coimbra: Almedina; 2011."},{"key":"1043_CR16","doi-asserted-by":"crossref","unstructured":"Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ et al. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J Pain Symptom Manage [Internet]. 2017;53:821\u2013832.e1. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0885392416312325.","DOI":"10.1016\/j.jpainsymman.2016.12.331"},{"key":"1043_CR17","doi-asserted-by":"crossref","unstructured":"ten Have H. Patr\u00e3o Neves M do C. Advance directives. Dictionary of Global Bioethics. Springer International Publishing; 2021. p. 97.","DOI":"10.1007\/978-3-030-54161-3_45"},{"key":"1043_CR18","unstructured":"Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine:.Convention on Human Rights and Biomedicine [Internet]. Republic Daily n.o 2\/2001, S\u00e9rie I-A de 2001-01-03; Jan 3, 2001. https:\/\/diariodarepublica.pt\/dr\/detalhe\/resolucao-assembleia-republica\/1-2001-235128."},{"key":"1043_CR19","unstructured":"Nunes R, Melo H. PARECER N.o P\/05\/APB\/06 SOBRE DIRECTIVAS ANTECIPADAS DE VONTADE [Internet]. 2006 May. Available from: www.apbioetica.org."},{"key":"1043_CR20","unstructured":"Republic Assembly. Law 25\/2012 [Internet]. Di\u00e1rio da Rep\u00fablica n.o 136\/2012, S\u00e9rie I de 2012-07-16; Jul 16. 2012 p. 3728\u201330. https:\/\/diariodarepublica.pt\/dr\/detalhe\/lei\/25-2012-179517."},{"key":"1043_CR21","unstructured":"Portugal - SPMS. Registo de testamentos vitais duplicou em 2022 \u2013 SPMS [Internet]. 2023. https:\/\/www.spms.min-saude.pt\/2023\/01\/registo-de-testamentos-vitais-duplicou-em-2022\/."},{"key":"1043_CR22","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1017\/S0963180122000743","volume":"32","author":"B Herreros","year":"2023","unstructured":"Herreros B, Gella P, Valenti E, M\u00e1rquez O, Moreno B, Velasco T. Improving the implementation of Advance directives in Spain. Camb Q Healthc Ethics. 2023;32:270\u20135.","journal-title":"Camb Q Healthc Ethics"},{"key":"1043_CR23","doi-asserted-by":"crossref","unstructured":"Kleiner AC, Santos-Eggimann B, Fustinoni S, D\u00fcrst AV, Haunreiter K, Rubli-Truchard E et al. Advance care planning dispositions: the relationship between knowledge and perception. BMC Geriatr. 2019;19.","DOI":"10.1186\/s12877-019-1113-3"},{"key":"1043_CR24","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1016\/j.socscimed.2005.08.010","volume":"62","author":"ML Rurup","year":"2006","unstructured":"Rurup ML, Onwuteaka-Philipsen BD, Van Der Heide A, Van Der Wal G, Deeg DJH. Frequency and determinants of advance directives concerning end-of-life care in the Netherlands. Soc Sci Med. 2006;62:1552\u201363.","journal-title":"Soc Sci Med"},{"key":"1043_CR25","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1111\/j.1467-8519.2009.01788.x","volume":"24","author":"MPS Van Wijmen","year":"2010","unstructured":"Van Wijmen MPS, Rurup ML, Pasman HRW, Kaspers PJ, Onwuteaka-Philipsen BD. Advance directives in the Netherlands: an empirical contribution to the exploration of a cross-cultural perspective on advance directives. Bioethics. 2010;24:118\u201326.","journal-title":"Bioethics"},{"key":"1043_CR26","unstructured":"Republic Assembly. Resolution of the Republic Assembly n.o1\/2017 [Internet]. Di\u00e1rio da Rep\u00fablica n.o 1\/2017, S\u00e9rie I de 2017-01-02; Jan 2, 2017 pp. 2\u20132. https:\/\/diariodarepublica.pt\/dr\/detalhe\/resolucao-assembleia-republica\/1-2017-105669745."},{"key":"1043_CR27","doi-asserted-by":"publisher","unstructured":"Wang Y, Zhang Y, Hong Y, Zeng P, Hu Z, Xu X et al. Advance directives and end-of-life care: knowledge and preferences of patients with brain Tumours from Anhui, China. BMC Cancer [Internet]. 2021 [cited 2021 Jun 28];21:25. https:\/\/bmccancer.biomedcentral.com\/articles\/https:\/\/doi.org\/10.1186\/s12885-020-07775-4.","DOI":"10.1186\/s12885-020-07775-4"},{"key":"1043_CR28","doi-asserted-by":"publisher","unstructured":"Lim MK, Lai PSM, Lim PS, Wong PS, Othman S, Mydin FHM. Knowledge, attitude and practice of community-dwelling adults regarding advance care planning in Malaysia: a cross-sectional study. BMJ Open [Internet]. 2022;12:e048314. https:\/\/bmjopen.bmj.com\/lookup\/doi\/https:\/\/doi.org\/10.1136\/bmjopen-2020-048314.","DOI":"10.1136\/bmjopen-2020-048314"},{"key":"1043_CR29","doi-asserted-by":"crossref","unstructured":"Laranjeira C, Dixe M dos, Gueif\u00e3o A, Caetano L, Passadouro L, Querido R. A. Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults. Healthcare [Internet]. 2021;9:648. https:\/\/www.mdpi.com\/2227-9032\/9\/6\/648.","DOI":"10.3390\/healthcare9060648"},{"key":"1043_CR30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/NJH.0000000000000487","volume":"21","author":"K Schnur","year":"2019","unstructured":"Schnur K, Radhakrishnan K. Young adult knowledge and readiness to Engage in Advance Care Planning behaviors. J Hospice Palliat Nurs. 2019;21:54\u201360.","journal-title":"J Hospice Palliat Nurs"},{"key":"1043_CR31","unstructured":"Hou XT, Lu YH, Yang H, Guo RX, Wang Y, Wen LH et al. The Knowledge and Attitude Towards Advance Care Planning Among Chinese Patients with Advanced Cancer. Journal of Cancer Education [Internet]. 2021 [cited 2023 Apr 18];36:603\u201310. https:\/\/click.endnote.com\/viewer?doi=10.1007%2Fs13187-019-01670-8&token=WzE2OTgwMTcsIjEwLjEwMDcvczEzMTg3LTAxOS0wMTY3MC04Il0.BtSnwfpyNgyYK1NakVQ9I2CJ4_s"},{"key":"1043_CR32","first-page":"44","volume":"9","author":"MLV Capelas","year":"2017","unstructured":"Capelas MLV, Coelho SPF, Silva SCF, Ferreira CMD, Pereira CMF, Alvarenga MISF, et al. Os Portugueses E o Testamento Vital. Cadernos De Sa\u00fade. 2017;9:44\u201353.","journal-title":"Cadernos De Sa\u00fade"},{"key":"1043_CR33","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344\u20139.","journal-title":"J Clin Epidemiol"},{"key":"1043_CR34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4081\/jphr.2021.1881","volume":"10","author":"C Laranjeira","year":"2021","unstructured":"Laranjeira C, Dixe M, dos Gueif\u00e3o A, Caetano L, Passadouro L, Gabriel R. Development and psychometric properties of the general public\u2019s attitudes toward advance care directives scale in Portugal. J Public Health Res. 2021;10:1\u20137.","journal-title":"J Public Health Res"},{"key":"1043_CR35","unstructured":"Kline RB. Principles and Practice of Structural Equation Modeling [Internet]. 4th edition. New York: Gulford Press; 2016. https:\/\/www.researchgate.net\/publication\/361910413."},{"key":"#cr-split#-1043_CR36.1","unstructured":"European Commission E. Regions in the European Union: nomenclature of territorial units for statistics, NUTS 2013\/EU-28 [Internet]. Publications Office"},{"key":"#cr-split#-1043_CR36.2","unstructured":"2015 [cited 2023 Sep 28]. https:\/\/op.europa.eu\/en\/publication-detail\/-\/publication\/a4f9243e-fa53-4798-90f4-bb51cb355a3a\/language-en."},{"key":"1043_CR37","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1080\/01634372.2016.1229709","volume":"59","author":"M Inoue","year":"2016","unstructured":"Inoue M. The influence of Sociodemographic and Psychosocial factors on Advance Care Planning. J Gerontol Soc Work. 2016;59:401\u201322.","journal-title":"J Gerontol Soc Work"},{"key":"1043_CR38","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1097\/00000441-200401000-00006","volume":"327","author":"HS Perkins","year":"2004","unstructured":"Perkins HS, Cortez JD, Hazuda HP. Advance Care Planning: does patient gender make a difference? Am J Med Sci. 2004;327:25\u201332.","journal-title":"Am J Med Sci"},{"key":"1043_CR39","doi-asserted-by":"publisher","unstructured":"Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J Pain Symptom Manage [Internet]. 2018;56:436\u2013459.e25. https:\/\/doi.org\/10.1016\/j.jpainsymman.2018.05.016.","DOI":"10.1016\/j.jpainsymman.2018.05.016"},{"key":"1043_CR40","doi-asserted-by":"crossref","unstructured":"Kim B, Choi J, Lee I. Factors Associated with Advance directives Documentation: a Nationwide Cross-sectional Survey of older adults in Korea. Int J Environ Res Public Health [Internet]. 2022;19:13. Available from: <go isi=\"to=\u201d>:\/\/WOS:000781829900001<\/go>.","DOI":"10.3390\/ijerph19073771"},{"key":"1043_CR41","doi-asserted-by":"crossref","unstructured":"Kim J, Heo S, Woo Hong S, Shim J, Lee J-A. Correlates of advance directive treatment preferences among community-dwelling older people with chronic diseases. Int J Older People Nurs. 2019;14.","DOI":"10.1111\/opn.12229"},{"key":"1043_CR42","doi-asserted-by":"publisher","first-page":"4183","DOI":"10.1007\/s00520-019-05253-7","volume":"28","author":"G Bar-Sela","year":"2020","unstructured":"Bar-Sela G, Bagon S, Mitnik I, Baziliansky S, Bar-Sella A, Vornicova O, et al. The perception of Israeli oncology staff members regarding advance care planning. Support Care Cancer. 2020;28:4183\u201391.","journal-title":"Support Care Cancer"},{"key":"1043_CR43","doi-asserted-by":"publisher","unstructured":"Ugalde A, O\u2019Callaghan C, Byard C, Brean S, MacKay J, Boltong A et al. Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer. Supportive Care in Cancer [Internet]. 2018 [cited 2023 Apr 18];26:3765\u201371. http:\/\/link.springer.com\/https:\/\/doi.org\/10.1007\/s00520-018-4241-y.","DOI":"10.1007\/s00520-018-4241-y"},{"key":"1043_CR44","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/j.jpainsymman.2020.04.013","volume":"60","author":"L Dhingra","year":"2020","unstructured":"Dhingra L, Cheung W, Breuer B, Huang P, Lam K, Chen J, et al. Attitudes and beliefs toward Advance Care Planning among Underserved Chinese-American immigrants. J Pain Symptom Manage. 2020;60:588\u201394.","journal-title":"J Pain Symptom Manage"},{"key":"1043_CR45","doi-asserted-by":"publisher","unstructured":"Yap SS, Chen K, Detering KM, Fraser SA. Exploring the knowledge, attitudes and needs of advance care planning in older Chinese Australians. J Clin Nurs [Internet]. 2018 [cited 2022 Oct 27];27:3298\u2013306. https:\/\/onlinelibrary.wiley.com\/doi\/full\/https:\/\/doi.org\/10.1111\/jocn.13886.","DOI":"10.1111\/jocn.13886"},{"key":"1043_CR46","unstructured":"Servi\u00e7os Partilhados do Minist\u00e9rio da Sa\u00fade. RENTEV - Registo Nacional do Testamento Vital [Internet]. 2023 [cited 2023 Mar 17]. https:\/\/www.spms.min-saude.pt\/2023\/01\/registo-de-testamentos-vitais-duplicou-em-2022\/."},{"key":"1043_CR47","unstructured":"Portugal-SPMS. RENTEV assinala 9 anos a registar testamentos vitais [Internet]. 2023 [cited 2023 Jul 14]. https:\/\/www.spms.min-saude.pt\/2023\/07\/rentev-assinala-9-anos-a-registar-testamentos-vitais\/."},{"key":"1043_CR48","doi-asserted-by":"crossref","unstructured":"Alano GJ, Pekmezaris R, Tai JY, Hussain MJ, Jeune J, Louis B et al. Factors influencing older adults to complete advance directives. Palliat Support Care. 2010. p. 267\u201375.","DOI":"10.1017\/S1478951510000064"},{"key":"1043_CR49","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1111\/jgs.13309","volume":"63","author":"D Dobbs","year":"2015","unstructured":"Dobbs D, Park NS, Jang Y, Meng H. Awareness and completion of advance directives in older Korean-American adults. J Am Geriatr Soc. 2015;63:565\u201370.","journal-title":"J Am Geriatr Soc"},{"key":"1043_CR50","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1136\/bmjspcare-2013-000473","volume":"5","author":"AA Teixeira","year":"2015","unstructured":"Teixeira AA, Hanvey L, Tayler C, Barwich D, Baxter S, Heyland DK. What do canadians think of advanced care planning? Findings from an online opinion poll. BMJ Support Palliat Care. 2015;5:40\u20137.","journal-title":"BMJ Support Palliat Care"},{"key":"1043_CR51","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1111\/jgs.12736","volume":"62","author":"MJ Silveira","year":"2014","unstructured":"Silveira MJ, Wiitala W, Piette J. Advance directive completion by elderly americans: a decade of change. J Am Geriatr Soc. 2014;62:706\u201310.","journal-title":"J Am Geriatr Soc"},{"key":"1043_CR52","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1377\/hlthaff.2017.0175","volume":"36","author":"KN Yadav","year":"2017","unstructured":"Yadav KN, Gabler NB, Cooney E, Kent S, Kim J, Herbst N, et al. Approximately one in three us adults completes any type of advance directive for end-of-life care. Health Aff. 2017;36:1244\u201351.","journal-title":"Health Aff"},{"key":"1043_CR53","doi-asserted-by":"crossref","unstructured":"De Vleminck A, Pardon K, Houttekier D, Van Den Block L, Vander Stichele R, Deliens L. The prevalence in the general population of advance directives on euthanasia and discussion of end-of-life wishes: a nationwide survey Ethics, organization and policy. BMC Palliat Care. 2015;14.","DOI":"10.1186\/s12904-015-0068-1"},{"key":"1043_CR54","doi-asserted-by":"crossref","unstructured":"Lack P, Biller-Andorno N, Brauer S, editors. Advance Directives. International Library of Ethics, Law, and the New Medicine [Internet]. 2014. http:\/\/www.springer.com\/series\/6224.","DOI":"10.1007\/978-94-007-7377-6"},{"key":"1043_CR55","unstructured":"Barreto ALF, Capela MLV. Conhecimento dos profissionais de sa\u00fade sobre as diretivas antecipadas de vontade. Cadernos de Sa\u00fade [Internet]. 2020 [cited 2023 Mar 10];12:36\u201340. https:\/\/revistas.ucp.pt\/index.php\/cadernosdesaude\/article\/view\/5834."},{"key":"1043_CR56","doi-asserted-by":"crossref","unstructured":"Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y et al. Report of the Lancet Commission on the Value of Death: bringing death back into life. The Lancet [Internet]. 2022; https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S014067362102314X.","DOI":"10.1016\/S0140-6736(21)02314-X"},{"key":"1043_CR57","doi-asserted-by":"crossref","unstructured":"Macedo JC, Rethinking Death Education as Part of Public Health Policy. Recent Developments in Medicine and Medical Research Vol 12 [Internet]. 2021 [cited 2022 May 26];173\u20139. https:\/\/stm.bookpi.org\/RDMMR-V12\/article\/view\/4689.","DOI":"10.9734\/bpi\/rdmmr\/v12\/12549D"},{"key":"1043_CR58","doi-asserted-by":"crossref","unstructured":"WASS H, A PERSPECTIVE ON THE CURRENT, STATE OF DEATH EDUCATION. Death Stud [Internet]. 2004;28:289\u2013308. http:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/07481180490432315.","DOI":"10.1080\/07481180490432315"},{"key":"1043_CR59","doi-asserted-by":"crossref","unstructured":"Periyakoil VS, Neri E, Kraemer H. No easy talk: a mixed methods study of doctor reported barriers to conducting effective end-of-life conversations with diverse patients. PLoS ONE. 2015;10.","DOI":"10.1371\/journal.pone.0122321"},{"key":"1043_CR60","doi-asserted-by":"crossref","unstructured":"Ferreira C, Nunes R. Living will: information verification and sharing in a Portuguese hospital. Revista Bio\u00e9tica [Internet]. 2019 [cited 2021 Apr 27];27:691\u20138. http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1983-80422019000400691&tlng=pt","DOI":"10.1590\/1983-80422019274352"},{"key":"1043_CR61","doi-asserted-by":"crossref","unstructured":"Kermel-Schiffman I, Werner P. Knowledge regarding advance care planning: a systematic review. Arch Gerontol Geriatr. Elsevier Ireland Ltd; 2017. pp. 133\u201342.","DOI":"10.1016\/j.archger.2017.07.012"},{"key":"1043_CR62","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1111\/imj.14261","volume":"49","author":"BP White","year":"2019","unstructured":"White BP, Willmott L, Tilse C, Wilson J, Ferguson M, Aitken J, et al. Prevalence of advance care directives in the community: a telephone survey of three Australian States. Intern Med J. 2019;49:1261\u20137.","journal-title":"Intern Med J"},{"key":"1043_CR63","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1089\/jpm.2019.0244","volume":"23","author":"A Sprange","year":"2020","unstructured":"Sprange A, Ismond KP, Hjartarson E, Chavda S, Carbonneau M, Kowalczewski J, et al. Advance Care Planning preferences and Readiness in cirrhosis: a prospective Assessment of patient perceptions and knowledge. J Palliat Med. 2020;23:552\u20137.","journal-title":"J Palliat Med"},{"key":"1043_CR64","doi-asserted-by":"crossref","unstructured":"Islam I, Nelson A, Longo M, Byrne A. Before the 2020 pandemic: an observational study exploring public knowledge, attitudes, plans, and preferences towards death and end of life care in Wales. BMC Palliat Care. 2021;20.","DOI":"10.1186\/s12904-021-00806-2"},{"key":"1043_CR65","doi-asserted-by":"crossref","unstructured":"Canny A, Mason B, Boyd K. Public perceptions of advance care planning (ACP) from an international perspective: a scoping review. BMC Palliat Care. 2023;22.","DOI":"10.1186\/s12904-023-01230-4"},{"key":"1043_CR66","doi-asserted-by":"crossref","unstructured":"Graham-Wisener L, Nelson A, Byrne A, Islam I, Harrison C, Geddis J et al. Understanding public attitudes to death talk and advance care planning in Northern Ireland using health behaviour change theory: a qualitative study. BMC Public Health. 2022;22.","DOI":"10.1186\/s12889-022-13319-1"},{"key":"1043_CR67","doi-asserted-by":"crossref","unstructured":"Macedo JC. Contribution to improve advance directives in Portugal. MOJ Gerontology & Geriatrics [Internet]. 2020 [cited 2021 Oct 10];5:27\u201330. https:\/\/medcraveonline.com\/MOJGG\/contribution-to-improve-advance-directives-in-portugal.html.","DOI":"10.15406\/mojgg.2020.05.00225"},{"key":"1043_CR68","doi-asserted-by":"crossref","unstructured":"B\u00fclow HH, Sprung CL, Reinhart K, Prayag S, Du B, Armaganidis A et al. The world\u2019s major religions\u2019 points of view on end-of-life decisions in the intensive care unit. Intensive Care Med. 2008. p. 423\u201330.","DOI":"10.1007\/s00134-007-0973-8"},{"key":"1043_CR69","unstructured":"Congregation for the Doctrine of the Faith. SAMARITANUS BONUS on the care of persons in the critical and terminal phases of life [Internet]. Rome. 2020 Sep. https:\/\/press.vatican.va\/content\/salastampa\/en\/bollettino\/pubblico\/2020\/09\/22\/200922a.html#."},{"key":"1043_CR70","doi-asserted-by":"publisher","unstructured":"Johnson S, Butow P, Kerridge I, Tattersall M. Advance care planning for cancer patients: a systematic review of perceptions and experiences of patients, families, and healthcare providers. Psychooncology [Internet]. 2016 [cited 2020 Jan 27];25:362\u201386. https:\/\/doi.org\/10.1002\/pon.3926.","DOI":"10.1002\/pon.3926"},{"key":"1043_CR71","doi-asserted-by":"crossref","unstructured":"McDermott E, Selman LE. Cultural factors influencing Advance Care Planning in Progressive, Incurable Disease: a systematic review with narrative synthesis. J Pain Symptom Manage. Elsevier Inc.; 2018. pp. 613\u201336.","DOI":"10.1016\/j.jpainsymman.2018.07.006"},{"key":"1043_CR72","doi-asserted-by":"crossref","unstructured":"True G, Phipps EJ, Braitman LE, Harralson T, Harris D, Tester W. Treatment Preferences and Advance Care Planning at End of Life: The Role of Ethnicity and Spiritual Coping in Cancer Patients. Annals of Behavioral Medicine [Internet]. 2005;30:174\u20139. https:\/\/academic.oup.com\/abm\/article\/30\/2\/174\/4631686.","DOI":"10.1207\/s15324796abm3002_10"},{"key":"1043_CR73","doi-asserted-by":"crossref","unstructured":"Herreros B, Benito M, Gella P, Valenti E, S\u00e1nchez B, Velasco T. Why have advance directives failed in Spain? BMC Med Ethics. 2020;21.","DOI":"10.1186\/s12910-020-00557-4"},{"key":"1043_CR74","doi-asserted-by":"publisher","unstructured":"Martins CS, Nunes R. Advanced directives\u2019 knowledge among Portuguese palliative patients and caregivers: do the sociodemographic factors influence it? A cross-sectional survey. BMC Palliat Care [Internet]. 2023;22:84. https:\/\/bmcpalliatcare.biomedcentral.com\/articles\/https:\/\/doi.org\/10.1186\/s12904-023-01203-7.","DOI":"10.1186\/s12904-023-01203-7"},{"key":"1043_CR75","doi-asserted-by":"crossref","unstructured":"Carbonneau M, Davyduke T, Spiers J, Brisebois A, Ismond K, Tandon P. Patient views on advance care planning in cirrhosis: A qualitative analysis. Can J Gastroenterol Hepatol. 2018;2018.","DOI":"10.1155\/2018\/4040518"},{"key":"1043_CR76","doi-asserted-by":"crossref","unstructured":"Martins CS, Sousa I, Barros C, Pires A, Castro L, Santos CD et al. Do surrogates predict patient preferences more accurately after a physician-led discussion about advance directives? A randomized controlled trial. BMC Palliat Care [Internet]. 2022;21:10. Available from: :\/\/WOS:000824900400004.","DOI":"10.1186\/s12904-022-01013-3"},{"key":"1043_CR77","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/S0140-6736(21)02314-X","volume":"399","author":"L Sallnow","year":"2022","unstructured":"Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, et al. Report of the Lancet Commission on the value of death: bringing death back into life. Lancet. 2022;399:837\u201384.","journal-title":"Lancet"},{"key":"1043_CR78","volume-title":"Death Education","author":"JC Macedo","year":"2020","unstructured":"Macedo JC. Death Education. Berlin: LAP LAMBERT Academic Publishing; 2020."},{"key":"1043_CR79","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1080\/09699260.2015.1103498","volume":"24","author":"K Noonan","year":"2016","unstructured":"Noonan K, Horsfall D, Leonard R, Rosenberg J. Developing death literacy. Prog Palliat Care. 2016;24:31\u20135.","journal-title":"Prog Palliat Care"},{"key":"1043_CR80","doi-asserted-by":"publisher","unstructured":"Gasc\u00f3n A, de la Herrero H, Peralta PR, Rodr\u00edguez IR. JJM. The Pedagogy of death and special needs education. A phenomenological study. Eur J Spec Needs Educ [Internet]. 2022;37:747\u201360. https:\/\/www.tandfonline.com\/doi\/full\/https:\/\/doi.org\/10.1080\/08856257.2021.1943269.","DOI":"10.1080\/08856257.2021.1943269"},{"key":"1043_CR81","unstructured":"Nunes R. PARECER No. P\/35\/APB\/19 Sobre a Proposta de Altera\u00e7\u00e3o da Lei N.o 25\/2012, de16 de JULHO [Internet]. 2019. https:\/\/upbioetica.org\/wp-content\/uploads\/2021\/01\/Parecer-No.-P_35_APB_19_Proposta-de-alterac%CC%A7a%CC%83o-da-Lei-que-Regula-as-Diretivas-Antecipadas-de-Vontade.pdf."},{"key":"1043_CR82","unstructured":"INE. Sociedade da Informa\u00e7\u00e3o e do Conhecimento - Inqu\u00e9rito \u00e0 Utiliza\u00e7\u00e3o de Tecnologias da Informa\u00e7\u00e3o e da Comunica\u00e7\u00e3o nas Fam\u00edlias [Internet]. 2022 [cited 2024 Jan 27]. https:\/\/www.ine.pt\/xportal\/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=541053235&DESTAQUESmodo=2"}],"container-title":["BMC Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12910-024-01043-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12910-024-01043-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12910-024-01043-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T10:02:17Z","timestamp":1712138537000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedethics.biomedcentral.com\/articles\/10.1186\/s12910-024-01043-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,3]]},"references-count":83,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1043"],"URL":"https:\/\/doi.org\/10.1186\/s12910-024-01043-x","relation":{},"ISSN":["1472-6939"],"issn-type":[{"value":"1472-6939","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,3]]},"assertion":[{"value":"29 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee of the Faculty of Medicine of the University of Porto (protocol approval n.\u00b0 59\/CEFMUP\/2022). All study procedures followed the recommendations of the Declaration of Helsinki and subsequent updates. All participants were assured of the anonymity and confidentiality of all the data provided. The participants were previously informed of the aims of the study, and informed consent was obtained for them to complete the form. There was no monetary or other payment for taking part in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"40"}}