Advance directives have little impact on EOL care
Advance directives have little, if any, effect on end-of-life (EOL) care for most patients, according to a study supported by the Princeton, NJ-based Robert Wood Johnson Foundation and the Rockville, MD-based Agency for Health Care Policy and Research.1
The reason is that few patients tell their doc- tor they have directives in place, and the directives often are too vague to make a difference in patient care anyway, researchers concluded. The conclusions were made after researchers reviewed the charts of more than 4,800 dying patients.
Only 688 charts contained written advance directives, and only 3% of those were specific enough to guide physicians’ decisions about a particular life-extending treatment in the patients’ situations. For those patients who had written advance directives, only one in 10 had discussed them with their physicians when writing the directive. Less than half had ever talked with any of their doctors about having a directive. About one-third had their wishes documented in the medical record.
The findings are based on the largest study to date on the impact of advance directives on seriously ill patients in U.S. hospitals. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment, referred to as the SUPPORT project, was a 10-year study of 10,000 patients hospitalized between 1989 and 1994 at five teaching hospitals.
Reference
1. Teno J, Licks S, et al. Do advance directives provide instructions that direct care? J Am Geriatr Soc 1997; 45:500-507. t
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