These data show that families are, for the most part, not in compliance with national recommendations for preparedness. Families who discussed preparedness with their primary care physician were more likely to be compliant.
Purpose-Advance directives have been criticized for failing to help physicians make decisions consistent with patients' wishes. This pilot study sought to determine if an interactive, computerbased decision aid that generates an advance directive can help physicians accurately translate patients' wishes into treatment decisions.Methods-We recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians' responses, a "consensus physician response" was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.Results-Patient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants' rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well).Physicians' overall rating of their confidence at accurately translating patients' wishes into clinical decisions was 7.8 (range = 6.
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