Preferences of Physicians and Their Patients for End-of-Life Care
Gramelspacher, Gregory P.
Hanna, Mark P.
Tierney, William M.
Journal of General Internal Medicine. 1997 Jun; 12(6): 346-351.
OBJECTIVE: Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians' and their patients' desires for end-of-life care for themselves. MEASUREMENTS AND MAIN RESULTS: Study physicians (n = 78) were residents and faculty practicing in an inner-city, academic primary care general internal medicine practice. Patients (n = 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians' and patients' preferences for all six treatments (p less than .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p less than .01) were more often male (odds ratio [OR] 1.7). African-American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians' preferences. A treatment preference score was calculated from respondents' desires to receive or refuse the six treatments. Physicians' scores were highly correlated with those of their enrolled primary care patients (r = .51, p less than .0001). CONCLUSIONS: Although patients and physicians as groups differ substantially in their preferences for end-of-life care, there was significant correlation between individual academic physicians' preferences and those of their primary care patients. Reasons for this correlation are unknown.
Advance Directives; Aged; Allowing to Die; Artificial Feeding; Attitudes; Chronically Ill; Communication; Comparative Studies; Faculty; Health; Health Care; Internal Medicine; Life; Medicine; Patients; Physicians; Primary Health Care; Prolongation of Life; Questionnaires; Resuscitation; Socioeconomic Factors; Surgery; Survey; Terminal Care; Terminally Ill; Ventilators; Withholding Treatment;
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Tierney, William M.; Dexter, Paul R.; Gramelspacher, Gregory P.; Perkins, Anthony J.; Zhou, Xiao-Hua; Wolinsky, Fredric D. (2001-01)
Effectiveness of Computer-Generated Reminders for Increasing Discussions About Advance Directives and Completion of Advance Directive Forms: A Randomized, Controlled Trial Dexter, Paul R.; Wolinsky, Fredric D.; Gramelspacher, Gregory P.; Zhou, Xiao-Hua; Eckert, George J.; Waisburd, Marina; Tierney, William M. (1998-01-15)BACKGROUND: Physicians can increase the rate of completion of advance directive forms by discussing directives with their patients, but the means by which physicians can be induced to initiate these discussions are unclear. ...