Perception of Advance Directive in Thai Women with Cancer:A Qualitative Study

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 interviews using a 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 3 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 participants were in the early stages of cancer. Five women were diagnosed with breast cancer, 7 with cervical cancer, and 3 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. Living wills may be useful tools for making AD in women with cancer but they need to be simplified

Managing Pre-hospital Emergency Medical Services of Road Traffic Injuries in Khon Kaen Province, Thailand

Road trauma is a public health issue worldwide. The Emergency Medical Service (EMS) focuses on improving trauma patient outcomes by providing medical care and transporting patients to the appropriate health facility as quickly as possible. The aim of this study is to provide basic knowledge and recommendations for the improvement of current EMS management practice in relation to road trauma, in particular, in Khon Kaen Province, Thailand. An understanding of current EMS operation in response to Road Traffic Injury (RTI) enhances knowledge that informs the management of EM Services and identifies factors that can achieve better patient outcomes. The study consists of two parts: (i) a description of a road traffic injury and EMS response profile based on data available from KKRH Trauma Registry and the KK EMS database for KK EMS health area, and (ii) an exploratory qualitative analysis using in-depth interviews with KK EMS staff to determine how EMS management and patient outcomes could be improved. Many important road traffic injury risks from an eight year period from 1998-2005 were identified such as being a motorcycle rider, a young male, working as a labourer, not wearing a helmet while riding two-wheeled vehicles, festival and weekend periods, and rural location. The available EMS data from 2003-2007 indicates that EMS responses are to some extent adequate for the requirement of emergency calls. However, the dramatic increase in non-urgent cases in the past several years indicates some level of inefficiency. In-depth interviews with 20 EMS staff, who had experience in EMS employment, provided data for the qualitative part of the study. Thematic analysis was used. EMS staff commented on a number of social issues particularly regarding issues associated with alcohol-related injuries of young male motorcyclists, lack of the public awareness of EM Service provision and the professionalism of EMS staff. The study highlights that the KK social context has an influence on the effectiveness of management of both road safety strategies and EMS provided. The recognition of the impact of local worldview of management needs to be considered in the management of EMS of RTI