Simple computer-generated reminders aimed at primary caregivers can increase the rates of discussion of advance directives and completion of advance directive forms among elderly outpatients with serious illnesses.

BACKGROUND: Discussions of end-of-life care should be held prior to acute, disabling events. Many barriers to having such discussions during primary care exist. These barriers include time constraints, communication difficulties, and perhaps physicians' anxiety that patients might react negatively to such discussions.

Elderly patients with chronic illnesses were more satisfied with their primary care physicians and outpatient visits when advanced directives were discussed. The improvement in visit satisfaction was substantial and persistent. This should encourage physicians to initiate such discussions to overcome communication barriers might result in reduced patient satisfaction levels.

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OBJECTIVE: Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians’ and their patients’ desires for end‐of‐life care for themselves. MEASUREMENTS AND MAIN RESULTS: Study physicians (n= 78) were residents and faculty practicing in an inner‐city, academic primary care general internal medicine practice. Patients (n= 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians’ and patients’ preferences for all six treatments (p < .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p < .01) were more often male (odds ratio [OR] 1.7), African‐American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians’ preferences. A treatment preference score was calculated from respondents’ desires to receive or refuse the six treatments. Physicians’ scores were highly correlated with those of their enrolled primary care patients (r= .51, p < .0001). CONCLUSIONS: Although patients and physicians as groups differ substantially in their preferences for end‐of‐life care, there was significant correlation between individual academic physicians’ preferences and those of their primary care patients. Reasons for this correlation are unknown. KEY WORDS: end‐of‐life care; advance directives; patient preferences; physician preferences.

OBJECTIVE:Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians' and their patients' desires for end-of-life care for themselves. MEASUREMENTS AND MAIN RESULTS:Study physicians ( n ‫؍‬ 78) were residents and faculty practicing in an inner-city, academic primary care general internal medicine practice. Patients ( n ‫؍‬ 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians' and patients' preferences for all six treatments ( p Ͻ .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care ( p Ͻ .01) were more often male (odds ratio [OR] 1.7), African-American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians' preferences. A treatment preference score was calculated from respondents' desires to receive or refuse the six treatments. Physicians' scores were highly correlated with those of their enrolled primary care patients ( r ‫؍‬ .51, p Ͻ .0001). CONCLUSIONS:Although patients and physicians as groups differ substantially in their preferences for end-of-life care, there was significant correlation between individual academic physicians' preferences and those of their primary care patients. Reasons for this correlation are unknown.KEY WORDS: end-of-life care; advance directives; patient preferences; physician preferences.

PCc significantly reduced charges in adult patients who died during their last hospitalization, even though the average LOS was higher for those who received a PCc versus those who did not.

BackgroundPatients in sub-Saharan Africa commonly experience pain, which often is un-assessed and undertreated. One hindrance to routine pain assessment in these settings is the lack of a single-item pain rating scale validated for the particular context. The goal of this study was to examine the face validity and cultural acceptability of two single-item pain scales, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), in a population of patients on the medical, surgical, and pediatric wards of Moi Teaching and Referral Hospital in Kenya.MethodsSwahili versions of the NRS and FPS-R were developed by standard translation and back-translation. Cognitive interviews were performed with 15 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya. Interview transcripts were analyzed on a question-by-question basis to identify major themes revealed through the cognitive interviewing process and to uncover any significant problems participants encountered with understanding and using the pain scales.ResultsCognitive interview analysis demonstrated that participants had good comprehension of both the NRS and the FPS-R and showed rational decision-making processes in choosing their responses. Participants felt that both scales were easy to use. The FPS-R was preferred almost unanimously to the NRS.ConclusionsThe face validity and acceptability of the Swahili versions of the NRS and FPS-R has been demonstrated for use in Kenyan patients. The broader application of these scales should be evaluated and may benefit patients who currently suffer from pain.