Advance Directives in Primary Care

Duffield, P.H.

doi:10.2307/3471529

Cited by 17 publications

(31 citation statements)

References 2 publications

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“…munication between patients and physicians (ie, a nurse implemented the intervention), not ensuring that patients' wishes were documented in readily accessible places (eg, the medical record), attempting to intervene at a suboptimal time (ie, a time of medical crisis) for promoting good communication about patients' wishes, 7 and not ad-dressing the cultural resistance to discussing end-of-life care that is common to patients and physicians. [8][9][10][11] Only a few published studies [12][13][14][15][16] of ACP have yielded heartening results. The most striking benefit was documented in a retrospective study of 540 decedents from La Crosse, Wis. 12 This study compared the prevalence of…”

Section: Original Investigationmentioning

confidence: 99%

Early Intervention in Planning End-of-Life Care With Ambulatory Geriatric Patients<subtitle>Results of a Pilot Trial</subtitle>

Schwartz

Wheeler²,

Hammes³

et al. 2002

Arch Intern Med

122

131

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Section: Original Investigationmentioning

confidence: 99%

Early Intervention in Planning End-of-Life Care With Ambulatory Geriatric Patients<subtitle>Results of a Pilot Trial</subtitle>

Schwartz

Wheeler²,

Hammes³

et al. 2002

Arch Intern Med

122

131

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“…Various attempts have been made to inform patients more aggressively about the advantage to them of expressing their wishes, with some limited success reported. [11][12][13][14][15] In some situations the physician and hospital are unaware that the patient had executed an AD. A question arises as to how patients perceive their concerns about their terminal illness, and what they actually specify in their ADs.…”

Section: Arch Internmentioning

confidence: 99%

What Do Patients Express as Their Preferences in Advance Directives?

Gross¹

1998

Arch Intern Med

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The overwhelming desire expressed by the patients in the ADs was not to have their lives prolonged if their medical condition were such that treatment would merely delay death. Only a minuscule number of patients, less than 0.7%, wanted everything done to prolong life regardless of the chance for improvement or the cost. Because such a small percentage of patients have ADs, it is recommended that each hospital appoint a committee on ADs to do everything possible to encourage patients to execute an AD. A second mission of this committee would be to do everything possible to encourage physicians to pay close attention to their patients' wishes for medical care at the end of life.

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“…However, controversies abound over using technologies, such as cardiopulmonary resuscitation, ventilation and artificial feeding, which may simultaneously extend life, but can also result in a poor quality of the end stages of life and dying with lack of dignity. A health policy concern over recent years has been to increase control and autonomy over decision-making at the end-of-life, for example by encouraging use of 'Do-NotAttempt-to-Resuscitate' (DNAR) orders and Living Wills or Advance Directives (Duffield and Podzansky 1996, Rodriguez and Young 2006, Carr and Khodyakov 2007. This medical policy development has conceptualised patients as independent and autonomous subjects, rather than as gendered persons.…”

Section: Introductionmentioning

confidence: 99%