Difficult End-of-Life Treatment Decisions -- Do Other Factors Trump Advance Directives?
Hardin, Steven B.
Yusufaly, Yasmin A.
Archives of Internal Medicine 2004 July 26; 164(14): 1531-1533
BACKGROUND: Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little evidence of their effectiveness. We devised a study to assess physicians' compliance with hypothetical advance directives and further examine their clinical reasoning. METHODS: The study consisted of an analysis of a mailed written survey containing 6 hypothetical cases of seriously ill patients. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Study participants were all internal medicine faculty and resident physicians from a single academic institution. RESULTS: A total of 47% analyzable surveys (117/250) were returned. Decisions by faculty and residents were not consistent with the advance directive in 65% of cases. This inconsistency was similar for faculty and residents (68% and 61%, respectively; P>.05). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions (89%; P
Showing items related by title, author, creator and subject.
Advance Directives: Assisting Patients With End-of-Life Decisions Advance Directives: Making Informed End-of-Life Decisions Unknown author (1996)"Talking with patients about the dying process and the use of life-sustaining technology can be emotionally challenging for all concerned. Helping patients to participate in planning for future health care crises, including ...
Death and Dying Sourcebook: Basic Consumer Health Information About End-of-Life Care and Related Perspectives and Ethical Issues, Including End-of-Life Symptoms and Treatments, Pain Management, Quality-of-Life Concerns, the Use of Life Support, Patients' Rights and Privacy Issues, Advance Directives, Physician-Assisted Suicide, Caregiving, Organ and Tissue Donation, Autopsies, Funeral Arrangements, and Grief, Along With Statistical Data, Information About the Leading Causes of Death, A Glossary, and Directories of Support Groups and Other Resources Shannon, Joyce Brennfleck (2006)