PolicyWhy hospital patients do and do not execute an advance directive☆,☆☆,★,★★,♢
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
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Cited by (36)
Views of African American Nursing Home Residents about Living Wills
2008, Geriatric NursingCitation Excerpt :However, even when no discussion with family members had taken place, the nursing home residents trusted their families to make the decisions. The results here mirror those of Mezey and colleagues5 who found that 45% of hospitalized African American patients without advance directives said that their family would decide what to do. The participants in the present study indicated that although they might not have discussed their end-of-life preferences with family members, they felt certain that their families were well aware of their preferences and that their family knew what end-of-life treatments they wanted.
Advance Directives Among Health Care Professionals at a Community-Based Cancer Center
2007, Mayo Clinic ProceedingsCitation Excerpt :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.
Advance directives among health care professionals at a community-based cancer center
2007, Mayo Clinic ProceedingsCitation Excerpt :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.
Factors influencing older adults to complete advance directives
2010, Palliative and Supportive CareDo Healthy People Engage With Education About Death, Dying and Advance Care Planning? An Early Evaluation of the Omega Course
2023, American Journal of Hospice and Palliative MedicineA survey on awareness and attitude towards living wills among community-dwelling elderly in Taiyuan city
2022, Chinese Journal of General Practitioners
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Robert Leitman is president, Louis Harris & Associates, Inc, New York, New York.
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Ethel L. Mitty is research scientist and adjunct assistant professor, New York University, School of Education, Division of Nursing.
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Melissa M. Bottrell is project director, New York University, School of Education, Division of Nursing.
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Gloria C. Ramsey is director of Legal and Ethical Aspects of Practice, New York University, School of Education, Division of Nursing.
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Supported by the Greenwall Foundation, New York City, and the Nathan Cummings Foundation.