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At least 19 recordsLinked to original sources
PubMedDate not supplied

Attitudes toward advance directives and advance directive completion rates.

BACKGROUND: The Patient Self-Determination Act (PSDA) (part of the ) requires that all healthcare institutions receiving Medicare and Medicaid funds inform patients about their right to participate in healthcare decisions, including their right to have an advance directive. Advance directives (ADs) allow an individual to participate indirectly in future medical care decisions if he or she becomes decisionally incapacitated. Despite passage of this bill and mechanisms within most healthcare institutions to provide this information, the AD completion rate remains low. PURPOSE: The purpose of this study was to identify the significant attitudes and factors that influence the completion of ADs among adult hospitalized patients admitted to medical/surgical units. DESIGN: Descriptive correlational survey design. METHODS: A convenience sample of patients admitted to medical-surgical units during a 2-month period completed face-to-face interviews and completion of the Advance Directive Attitude Survey. FINDINGS: Eighty-two percent of the sample identified having received information on ADs, although hospital policy had it distributed to all patients on admission. Eighteen percent of the sample had completed an AD, and an additional 8% completed an AD after the interview and accompanying education during the interview for a 26% completion rate. The mean attitude toward ADs was slightly positive, and there was no difference in attitude score between those with an AD and those without. IMPLICATIONS: Low completion rates of ADs among the majority of the population and even lower among ethnically diverse individuals despite favorable attitudes toward ADs suggest that there are factors beyond access to information that may influence the decision not to complete an AD. Results of this study are congruent with other research raising the question of whether ADs as currently designed are appropriate for all groups.

Adult↗
PubMed2004

Resuscitating advance directives.

Advance directives have not fulfilled their promise of facilitating decisions about end-of-life care for incompetent patients. Many legal requirements and restrictions concerning advance directives are counterproductive. Requirements for witnessing or notarizing advance directives make it difficult for patients to complete a written directive during a physician visit. State laws that establish a hierarchy of family surrogates for incompetent patients who have not appointed a proxy are inflexible and may not apply to common clinical situations. Advance directives would be more useful if they emphasized discussing end-of-life care with physicians rather than completing a legal document. State laws should be revised to encourage patients to discuss advance directives with physicians and to complete them during an office visit. Such patient-physician discussions about end-of-life care can lead to more informed patient decisions. Procedures for written advance directives should be simplified. Patients should be able to designate health care proxies through oral statements to physicians. These reforms will encourage discussions between patients and physicians about advance directives and may lead to more informed decisions near the end of life.

Advance Directives↗
PubMed1989

Physicians' attitudes on advance directives.

Advance directives provide means for competent individuals to influence treatment decisions in the event of serious illness and subsequent loss of competence, the "living will" being the best known example. Physicians in Arkansas who were identified to be currently engaged in general practice, family medicine, or internal medicine, including its subspecialities (N = 1293), were surveyed to assess attitudes toward and experiences with advance directives. Almost 80% of all respondents expressed a positive attitude and fewer than 2% expressed a negative attitude toward such documents. A majority (55.9%) had actual experience with the instruments in their practices, and 83.5% of these physicians said that their attitude had become more positive as a result of their experience. More frequent employment of advance directives in critical situations was associated with more positive attitudes and experiences. Most of the benefits claimed for advance directives--improved communication and trust, easier and more confident treatment decision, less stress and guilt, and promotion of patient autonomy--were substantiated by the results.

Arkansas↗
PubMedDate not supplied

Interpretation of an ambiguous advance directive.

Advance directives are statements made by a person who is capable of making decisions regarding health care choices that need to be applied at a future time when the person may no longer be capable of decision making. A patient may present a life-threatening condition with an ambiguous advance directive, and a delay in decision making could compromise the patient outcome. This article describes a case and includes an analysis of a situation where there is an ambiguous advance directive. Suggestions to the critical care nurse are provided.

Advance Directives↗
PubMedDate not supplied

A study of the public's knowledge regarding advance directives.

Advance directives are legal documents used to indicate individuals' wishes concerning medical care and treatment in the event that they are no longer able to do so. This study assessed the level of knowledge of 157 adults concerning advance directives and other medical terminology related to end-of-life events. Results indicated that 57% to 79% of respondents demonstrated an understanding of four to five major elements related to advance directives. There were no significant differences in level of understanding among groups of differing ethnicity, religion, and gender. Nor were there significant correlations found between level of understanding and the respondents' age and years of education.

Adolescent↗
PubMed1997

Improving the use of advance directives.

Advance directives are a valuable form of medical planning and well-accepted by patients. They are part of preventive health care and should be included as routine care. Completion of these documents is a process requiring patient/physician communication and can be effectively completed over several visits. Periodic reassessment of patient attitudes is important. Finally, including these documents in the patient record and communication of this information is important, as it helps shepherd the patient through the medical system. Physician investment in the use of advance directives is minimal, while the rewards are prodigious.

Advance Directives↗
PubMed1992

Role of the physician in encouraging use of advance directives.

Advance directives provide patients with the chance to tailor health care decisions to their own values even after they have lost the capacity to make decisions. Federal legislation enacted in 1990 and now effective will ensure widespread awareness of this opportunity. However, the extent to which advance directives actually contribute to improving patient care will depend much more on how physicians educate and counsel their patients than on what the law mandates.

Advance Directives↗
PubMed1998

Implementing advance directives.

Advance directives have an important place in medical practice. They promote planning for patients' medical care in unforeseen circumstances like unconsciousness from stroke or accident, when thinking and reasoning are impaired such as during a critical illness, and for patients facing death from conditions like terminal cancer or Alzheimer's Disease.

Advance Directives↗
PubMed1992

Advance directives.

Advance directives concerning treatment have been firmly established in our society. Reactions to them, however, are varied, especially when the health care provider possesses a different belief about the care, or non-provision of care, in a particular situation. It is important for the neuroscience nurse to be in touch with thoughts and feelings concerning a patient's treatment choice, and, when necessary, to seek input and support about those concerns. Clearly, if the nurse cannot carry out the patient's wishes, the nurse can use applicable state law provisions supported by the Patient Self-Determination Act, and request not to participate in the care of that patient. If, however, the neuroscience nurse does provide care, ethically and legally it must be done in accordance with the patient's expressed choices.

Advance Directives↗
PubMed2005

From advance directives to advance care planning: current legal status, ethical rationales and a new research agenda.

This paper uses a case example to review the current legal status of advance directives, as well as their ethical rationale. We draw attention to ongoing efforts to institutionalize advance directives, and to some of the tractable and intractable reasons why advance directives are ineffective. We then introduce the concept of advance care planning, and argue that we should not assume that advance care directives have a place in this process. We conclude by offering three reasons why this assumption may operate, and by suggesting that contingency and uncertainty may sometimes overwhelm all rational approaches to medical care.

Advance Care Planning↗
PubMed2001

The underachieving advance directive: recommendations for increasing advance directive completion.

Advance directives have failed to achieve a substantial completion rate nationwide despite prior efforts. We hypothesize that the continued low completion rate itself inhibits their utility and application. In this commentary we recommend linking the completion of advance directives to the time when health insurance is initiated or renewed by amending the Patient Self Determination Act. This would relocate the time and locus of their completion from the emotional turmoil of hospital admission and acute illness to a more equanimous time when family and others can be consulted and involved. Moreover actuating increased utilization may require non-coercive incentives as well as education. Amending the Patient Self Determination Act to require providing advance directive forms at the initiation of healthcare insurance in conjunction with educational and/or incentives could be more effective than the current arrangements.

Advance Care Planning↗
PubMed1998

Effectiveness of computer-generated reminders for increasing discussions about advance directives and completion of advance directive forms. A randomized, controlled trial.

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. Computer-generated reminders have been shown to increase physician compliance with practice guidelines. OBJECTIVE: To determine the effects of computer-generated reminders to physicians on the frequency of advance directive discussions between patients and their primary caregivers and the frequency of consequent establishment of advance directives. DESIGN: Randomized, controlled trial with a 2 x 2 factorial design. SETTING: An outpatient general medicine practice associated with an urban public hospital. PARTICIPANTS: Participants were 1) 1009 patients who were at least 75 years of age or were at least 50 years of age with serious underlying disease and 2) 147 primary care physicians (108 housestaff and 39 faculty). INTERVENTION: Computer-generated reminders that recommended discussion of one or both of two types of advance directives compared with no reminders. MEASUREMENTS: Discussions about advance directives, determined by patient interviews after all scheduled patient-physician outpatient encounters, and completed advance directive forms. The study period was approximately 1 year. RESULTS: Physicians who did not receive reminders (controls) discussed advance directives with 4% of the study patients compared with 24% for physicians who received both types of reminders (adjusted odds ratio, 7.7 [95% CI, 3.4 to 18]; P < 0.001). Physicians who did not receive reminders completed advance directive forms with only 4% of their study patients compared with 15% for physicians who received both types of reminders (adjusted odds ratio, 7.0 [CI, 2.9 to 17]; P < 0.001). Overall, 45% of patients with whom advance directives were discussed completed at least one type of advance directive. CONCLUSIONS: Simple computer-generated reminders aimed at primary caregivers can increase the rates of discussion of advance directives and completion of advance directive forms among elderly outpatients with serious illnesses.

Advance Care Planning↗