Advance Directives as Acts of Communication

Ditto, Peter H.; Danks, Joseph H.; Smucker, William D.; Bookwala, Jamila; Coppola, Kristen M.; Dresser, Rebecca; Fagerlin, Angela; Gready, Robert; Houts, Renate; Lockhart, Lisa K.; Zyzanski, S. J.

doi:10.1001/archinte.161.3.421

Cited by 377 publications

(321 citation statements)

References 73 publications

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“…Terminally ill patients in Western countries can specify their medical care for end of life situations in an advanced directive document, such as a living will or a durable power of attorney of health care (10,11). Considering the cultural background, a living will or advance directive is not a usual medical practice for terminally ill patients in Korea.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

Kim

Lee

et al. 2006

Cancer Res Treat

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Section: Discussionmentioning

confidence: 99%

An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea

Kim

Lee

et al. 2006

Cancer Res Treat

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“…28 This is problematic because family members are frequently unfamiliar with the procedures involved in CPR, lack accurate information about patients' prognoses, and routinely overestimate patients' preferences for CPR and other life-sustaining treatments. 31,32 DNR discussions fail to satisfy criteria for informed consent. DNR discussions often omit essential information to allow patients or surrogates to make informed decisions.…”

Section: Problems With Dnr Orders In Practicementioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes-to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient selfdetermination and avoiding non-beneficial interventions at the end of life.KEY WORDS: do-not-resuscitate orders; informed consent; end-of-life care.

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“…17,18,21,[25][26][27][28][29][30][31][32] In such studies, individuals are asked what they would want for themselves in particular circumstances. Their loved ones or designated proxies are then asked to predict what the patient would have wanted.…”

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

“…33 Studies have tried to improve the accuracy of surrogate decisions by facilitating conversations and providing instructional materials. They have generally been unsuccessful 32 or have improved predictions only modestly. 14,19 Finally, there has been extensive research examining whether patients really want their prior wishes to be the sole basis for decisions made on their behalf.…”

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%