Elsevier

Nursing Outlook

Volume 48, Issue 4, July–August 2000, Pages 165-171
Nursing Outlook

Policy
Why hospital patients do and do not execute an advance directive,☆☆,,★★,

https://doi.org/10.1067/mno.2000.101772Get rights and content

Abstract

Level of education was found to be the most important factor differentiating between patients who did and did not execute an advance directive in a study in which the extent to which race, education, language spoken, and income are associated with reasons for executing or not executing a directive.

Nurs Outlook 2000;48:165–71.

Section snippets

Sample

The sample of 1016 patients was randomly drawn from lists of patients discharged from 4 tertiary care hospitals in New York City (minimum of 250 patients per hospital). Patients were excluded from the study if they were: (1) younger than 18 years, (2) unable to respond to questions in English or Spanish, (3) admitted to obstetrics, gynecology, drug and alcohol service, or psychiatry, and (4) admitted from or discharged to a nursing home. Only discharged patients themselves were eligible to

Sample

The mean sample age was age 52 years (range 18–94); 56% of respondents were women. Of the 1016 patients, 20.4% (n = 207) had an advance directive at the time of survey, 76.7% (n = 779) did not have an advance directive, and 2.9% (n = 30) did not know their proxy status (Total: 809) (Table 1).Patients who did not know their proxy status did not vary significantly from those who lacked an advance directive. Almost half of these directives were formulated during or since hospitalization. Three

Discussion

How patients communicate health problems, decide when and to whom they go for care, and comply with a medical regimen are all known to be affected by race and socioeconomic factors.16, 18, 19, 20 Our findings underscore the differences in knowledge, opinions, and actions of discharged hospital patients, who are diverse regarding race and class and execution of an advance directive, and shed new light as to why patients do not execute directives.

A majority (65%) of white, college-educated

References (29)

  • BJ. Collopy

    Frail but still autonomous. The self-determination of the elderly in long-term care. The critical role of care providers

  • The SUPPORT Study

    Principal Investigators for the SUPPORT Project. A controlled trial to improve care for seriously ill hospitalized patients

    JAMA

    (1995)
  • Omnibus Budget Reconciliation Act of 1990, Pub. L. No. 101508, (4206, 4751 codified in scattered sections of 42 USC,...
  • LL Emanuel et al.

    Advance directives for medical care. A case for greater use

    N Engl J Med

    (1991)
  • BJ Collopy et al.

    New directions in nursing home ethics

    Hastings Center Report

    (1991)
  • LJ Fitten et al.

    Assessing treatment decision-making capacity in elderly nursing home residents

    J Am Geriatr Soc

    (1990)
  • EJ Emanuel et al.

    How well is the Patient Self-Determination Act working: an early assessment

    Am J Med

    (1993)
  • Department of Health and Human Services, Office of the Inspector General

    Patient advance directives: early implementation experience

    (1993)
  • Department of Health and Human Services, Office of the Inspector General

    Patient advance directives: facility and patient responses

    (1993)
  • S Risdon et al.

    Implementing the Patient Self Determination Act (PSDA): a survey of selected hospitals and skilled nursing facilities in Los Angeles County

    (1993)
  • HR Glick et al.

    The U. S. Supreme Court, Congress, and the right to die: impact and policy implications

    (1994 Mar 10–12)
  • T Wetle et al.

    Developing model policies for implementing the Patient Self Determination Act in nursing homes

    Gerontologist

    (1994)
  • DC Park et al.

    Implementation of the Patient Self Determination Act: a study of its impact

    Southern Med J

    (1994)
  • DM High

    Advance directives and the elderly: a study of intervention strategies to increase use

    Gerontologist

    (1993)
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      To our knowledge, no study that systematically investigates the barriers to AD completion among health care professionals has been published. In contrast, similar studies have been performed among patients, and by far the 2 most commonly cited barriers are inadequate understanding of or difficulty completing AD documents and lack of physician initiative to discuss ADs.8–10 In contrast, the cancer care professionals who responded to our survey did not cite these 2 reasons, as would be expected given their awareness of and familiarity with advance care planning.

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    Robert Leitman is president, Louis Harris & Associates, Inc, New York, New York.

    ☆☆

    Ethel L. Mitty is research scientist and adjunct assistant professor, New York University, School of Education, Division of Nursing.

    Melissa M. Bottrell is project director, New York University, School of Education, Division of Nursing.

    ★★

    Gloria C. Ramsey is director of Legal and Ethical Aspects of Practice, New York University, School of Education, Division of Nursing.

    Supported by the Greenwall Foundation, New York City, and the Nathan Cummings Foundation.

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