Advance Directives and Outcomes of Surrogate Decision Making before Death
By M. Silveira, Scott Y. H. Kim, Kenneth M. Langa. New England Journal of Medicine, 2010
1,250 citations recorded by the source corpus.
Background Recent discussions about health care reform have raised questions regarding the value of advance directives. Methods We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Results Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Conclusions Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.
Subfields: Clinical Psychology, General Health Professions, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/6506ee75666c483b9262773595016021e5335db3
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Citations in the corpus
- Redefining the “Planning” in Advance Care Planning: Preparing for End-of-Life Decision Making (2010, background): “Although advance directives have shown benefit in some cases (7, 8), they frequently do not affect the quality of end-of-life care or improve clinician and surrogate knowledge of patient preferences (9–13).”
- Systematic Review: The Effect on Surrogates of Making Treatment Decisions for Others (2011, background): “Up to 40% of hospitalized adults (1), 70% of older adults for whom treatment decisions are required (2), and approximately 95% of critically ill adults (3, 4) cannot make treatment decisions (5).”
- Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis (2014, background): “Patients who discuss advance care planning with their clinicians are more likely to receive end-of-life care that is consistent with their preferences (Detering et al., 2010; Mack et al., 2010; Silveira et al., 2010).”
- Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. (2017, background): “The panel recognized that many patients retain their decision making capacity at the end of life.(1) Therefore, patient preparation, through self-reflection and communication of values and goals, helps to clarify care preferences both for the patient as they subsequently face important decisions and”
- American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer (2012, neutral): “Clinical ethicists recommend that naming a surrogate decision maker is the most important feature of advance directives (145,146).”