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Do Advance Directives Undermine Advance Care Planning?
An advance directive (AD) is a legal document that becomes operational when a patient loses decisional capacity; it can state treatment goals and preferences, designate a surrogate decision-maker, or serve both functions. ADs are considered to be a key element of advance care planning (ACP). In this qualitative study, U.S. researchers conducted telephone interviews with 29 community-dwelling adults (median age, 72) who had been admitted and discharged from the hospital for a chronic medical illness (e.g., cancer, heart failure, lung disease) to explore their views regarding ADs and ACP.
Researchers discerned three themes from the 20 participants who had ADs: (1) AD forms were generic, captured few details, and often were completed with the assistance of attorneys rather than family members or clinicians; (2) participants could not remember details of their completed ADs and never revisited them; and (3) participants cited a completed AD as a reason for not discussing goals of care with family members or clinicians.
As someone who has done research on ADs, I am not surprised by these results, which support the belief that ADs can undermine ACP. In my opinion, ADs are primarily useful for designating surrogates and articulating general healthcare values, goals, and preferences but are not a substitute for robust ACP. Clinicians should review the ADs of patients with serious illnesses, recommend AD modifications if appropriate, and have and document ACP conversations. In my experience, patients with serious illness welcome these discussions.
Auriemma CL et al.
Title: How traditional advance directives undermine advance care planning: If you have it in writing, you do not have to worry about it.
Source: JAMA Intern Med 2022 Apr 25; [e-pub]. (Abstract/FREE Full Text)