Tags

Type your tag names separated by a space and hit enter

Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness.
Arch Intern Med. 1992 Oct; 152(10):2114-22.AI

Abstract

OBJECTIVE

To determine whether brief general instructions in a typical proxy-instruction advance directive (California Durable Power of Attorney for Health Care [DPAHC]) provide interpretable information about patient requests to limit life-saving treatments, and to determine whether patient treatment preferences are stable over time.

DESIGN

Prospective structured interviews.

SETTING

University of California, San Diego Medical Center and Veterans Affairs Medical Center, La Jolla.

PATIENTS

One hundred four patients (from a randomly chosen sample of 185) with a 5-year life expectancy of no better than 50% as judged by their physicians.

MAIN OUTCOME MEASURES

Patients completed the California DPAHC, a proxy-instruction advance directive, at entry and at 1 year. The patients also completed a questionnaire at entry, after 6 months, and after 1 year, indicating their preferences on a five-point Likert-format comparative rating scale for cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition, and hospitalization for pneumonia.

RESULTS

Sixty-eight percent of the subjects executed the DPAHC. Most patients wished treatments to be limited or withheld under certain conditions of reduced quality of life. Although general instructions noted on the DPAHC and preferences regarding specific procedures were stable over the course of a year, the advance directive's general instructions were often inconsistent with, and poor predictors of, specific procedure preferences.

CONCLUSIONS

The brief general instruction component of the California DPAHC is not helpful in communicating patient wishes regarding specific life-saving procedures.

Authors+Show Affiliations

Division of Health Care Sciences, University of California, San Diego School of Medicine, La Jolla 92093-0622.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

1417386

Citation

Schneiderman, L J., et al. "Relationship of General Advance Directive Instructions to Specific Life-sustaining Treatment Preferences in Patients With Serious Illness." Archives of Internal Medicine, vol. 152, no. 10, 1992, pp. 2114-22.
Schneiderman LJ, Pearlman RA, Kaplan RM, et al. Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness. Arch Intern Med. 1992;152(10):2114-22.
Schneiderman, L. J., Pearlman, R. A., Kaplan, R. M., Anderson, J. P., & Rosenberg, E. M. (1992). Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness. Archives of Internal Medicine, 152(10), 2114-22.
Schneiderman LJ, et al. Relationship of General Advance Directive Instructions to Specific Life-sustaining Treatment Preferences in Patients With Serious Illness. Arch Intern Med. 1992;152(10):2114-22. PubMed PMID: 1417386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness. AU - Schneiderman,L J, AU - Pearlman,R A, AU - Kaplan,R M, AU - Anderson,J P, AU - Rosenberg,E M, PY - 1992/10/1/pubmed PY - 1992/10/1/medline PY - 1992/10/1/entrez KW - California Durable Power of Attorney for Health Care KW - Death and Euthanasia KW - Empirical Approach SP - 2114 EP - 22 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 152 IS - 10 N2 - OBJECTIVE: To determine whether brief general instructions in a typical proxy-instruction advance directive (California Durable Power of Attorney for Health Care [DPAHC]) provide interpretable information about patient requests to limit life-saving treatments, and to determine whether patient treatment preferences are stable over time. DESIGN: Prospective structured interviews. SETTING: University of California, San Diego Medical Center and Veterans Affairs Medical Center, La Jolla. PATIENTS: One hundred four patients (from a randomly chosen sample of 185) with a 5-year life expectancy of no better than 50% as judged by their physicians. MAIN OUTCOME MEASURES: Patients completed the California DPAHC, a proxy-instruction advance directive, at entry and at 1 year. The patients also completed a questionnaire at entry, after 6 months, and after 1 year, indicating their preferences on a five-point Likert-format comparative rating scale for cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition, and hospitalization for pneumonia. RESULTS: Sixty-eight percent of the subjects executed the DPAHC. Most patients wished treatments to be limited or withheld under certain conditions of reduced quality of life. Although general instructions noted on the DPAHC and preferences regarding specific procedures were stable over the course of a year, the advance directive's general instructions were often inconsistent with, and poor predictors of, specific procedure preferences. CONCLUSIONS: The brief general instruction component of the California DPAHC is not helpful in communicating patient wishes regarding specific life-saving procedures. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/1417386/Relationship_of_general_advance_directive_instructions_to_specific_life_sustaining_treatment_preferences_in_patients_with_serious_illness_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/152/pg/2114 DB - PRIME DP - Unbound Medicine ER -