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ADVANCE DIRECTIVES: ARE THEY BEING DISCUSSED?

Few patients have living wills or durable power of attorney, although these written advance directives are widely advocated. Two surveys examined physician and patient attitudes toward using advance directives.

The first study interviewed 258 consecutive patients admitted to a medicine service of an urban hospital. Of 212 competent patients, about 85 percent said they had discussed diagnosis and treatment with their physicians, 64 percent had discussed severity of illness, 47 percent had discussed CPR, and 38 percent had discussed intensive-care options. Eighty-one percent had either discussed or wanted to discuss advance directives, and 90 percent met at least one of three indications for such discussions mentioned by physicians: age of 75 or older, critical illness, and desire to discuss directives.

The second survey asked 277 internal medicine residents and attending physicians at an urban hospital about barriers to advance directive discussions. Nearly 90 percent of physicians said they had discussed directives with fewer than 10 percent of their patients during the past month; half of these discussions were with inpatients. Self- perceived lack of knowledge, time constraints, and lack of comfort were significantly associated with physicians' failure to initiate the discussions. Physicians' lack of knowledge about advance directives and erroneous beliefs about the appropriateness of discussing them predicted the frequency of these discussions overall, whether initiated by patient or physician.

Comment: As an editorial notes, these studies suggest that many physicians do not discuss advance directives with their patients despite the fact that most patients desire or are willing to engage in such discussions.

— CD Mulrow

Published in Journal Watch General Medicine November 1, 1994

Citation(s):

Loewy EH; Carlson RW. Talking, advance directives, and medical practice. Arch Intern Med 1994 Oct 24 154 2265-2267.

• Medline abstract (Free)

Morrison RS et al. Physician reluctance to discuss advance directives. Arch Intern Med 1994 Oct 24 154 2311-2318.

• Medline abstract (Free)

Reilly BM et al. Inpatient discussions about advance directives in a community hospital. Arch Intern Med 1994 Oct 24 154 2299-2308.

• Medline abstract (Free)