The effect of discussions about advance directives on patients’ satisfaction with primary care

Tierney, William M.; Dexter, Paul; Gramelspacher, Gregory P.; Perkins, Anthony J.; Zhou, Xiao‐Hua; Wolinsky, Fredric D.

doi:10.1046/j.1525-1497.2001.00215.x

Cited by 99 publications

(59 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clinicians frequently avoid end-of-life discussions, even though people are more satisfied when the topic is discussed. 18 When the topic is broached, it may be particularly challenging for individuals with inadequate literacy to understand [19][20][21] ; tools such as video decision-aids are useful to ensure that education about complex topics such as ADs takes place and can help facilitate clinicianpatient communication. 21 Several reports have presented additional evidence that support the relationship between low literacy and having an AD.…”

Section: Discussionmentioning

confidence: 99%

Literacy and Race as Risk Factors for Low Rates of Advance Directives in Older Adults

Waite

Federman

McCarthy

et al. 2013

J American Geriatrics Society

View full text Add to dashboard Cite

Background Advance directives are documented instructions by a patient to ensure their medical care preferences are fulfilled in the event they cannot communicate with clinicians or family members. Objectives The current study examined the relationship between literacy and other patient level factors on having an advance directive. Design Face-to-face structured interview. Setting Participants were recruited from either an academic general internal medicine clinic or one of four federally qualified health centers in Chicago. Participants 784 adults ages 55 to 74. Measurements Assessment of participant literacy, sociodemographic factors, and having an advance directive for medical care. Results Having an advanced directive was reported by 12.4% of subjects with low literacy, 26.6% of those with marginal literacy, and 49.5% of those with adequate literacy (p<0.001). In multivariable analyses, both literacy and race were independently associated with a lower likelihood of having an advance directive. Specifically, people with limited literacy and African Americans were less likely to have an advance directive (RR, 0.45; 95% CI, 0.22–0.95; RR, 0.64; 95% CI: 0.47–0.88, respectively). Exploratory analyses exhibited that there was not a significant interaction between the effect of literacy and race. Conclusion Limited literacy and African American race were significant risk factors to not having an advance directive in this cohort of older patients. Literacy and race likely represent two separate but important causal pathways that need to be understood to improve how the health care system ascertains and protects patients’ advanced care preferences.

show abstract

Section: Discussionmentioning

confidence: 99%

Literacy and Race as Risk Factors for Low Rates of Advance Directives in Older Adults

Waite

Federman

McCarthy

et al. 2013

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…The potential uncertainty regarding prognosis in HF makes routine advance care planning even more appropriate in this population to avoid forcing patients and family members to make abrupt decisions when patients are facing critical illness unexpectedly. While timing of these discussions may be difficult in a busy clinical practice, as a recent Scientific Statement on decision-making in advanced HF notes “on the day of hospital admission, it is far better to review rather than introduce advanced care decisions.” 41 Second, though data has shown that patient-physician advance care planning discussions improve patient satisfaction 42 , many physicians are hesitant to partake in such conversations at the risk of taking away hope and hastening death. However, recent evidence suggests that having discussions about AD does not decrease survival 43 .…”

Section: Discussionmentioning

confidence: 99%

Advance Directives in Community Patients With Heart Failure

Dunlay

Swetz

Mueller

et al. 2012

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background While it is recommended that all patients with heart failure (HF) have advance directives (AD) in place before the end of life is imminent, the use of AD in HF has not been well studied. Methods and Results We enrolled consecutive Olmsted County residents presenting with HF from October 2007 through October 2011 into a longitudinal study. Information from AD completed prior to enrollment and hospitalizations in the month prior to death were abstracted. Among 608 patients (mean age 74.0 years, 54.9% male, 65.3% NYHA functional class 3 or 4) 164 (27.0%) patients died after a mean follow-up of 1.8 years. At enrollment, only 249 (41.0%) patients had an AD. While most AD appointed a proxy decision-maker (90.4%), less than half addressed wishes regarding use of cardiopulmonary resuscitation (41.4%), mechanical ventilation (38.6%), or hemodialysis (10.0%) at the end of life. The independent predictors of AD completion were older age (adjusted OR per 10-year increase 1.82, 95% CI 1.51–2.20), malignancy (OR 1.58, 95% CI 1.05–2.37) and renal dysfunction (OR for eGFR<60 mL/min 1.55, 95% CI 1.05–2.29). At the end of life, patients with AD specifying limits in the aggressiveness of care less frequently received mechanical ventilation (OR 0.26 95% CI 0.07–0.88) with a trend toward decreased intensive care unit admission (OR 0.45, 95% CI 0.16–1.29). Conclusions Despite a high mortality rate, over half of patients with HF do not have an AD, and existing AD fail to address important end of life medical decisions.

show abstract

“…Little research has been conducted on ACP in dementia. Previous research on non-demented populations suggests that earlier discussions may be associated with an increase in feelings of autonomy [7], maintenance of control, patient satisfaction [8], [9] and improved quality of care and reduced stress, anxiety and depression in family members [10].…”

Section: Introductionmentioning

confidence: 99%

Qualitative Evaluation of Advanced Care Planning in Early Dementia (ACP-ED)

2013

View full text Add to dashboard Cite

BackgroundEnd-of-life-care is often poor in individuals with dementia. Advanced care planning (ACP) has the potential to improve end-of-life care in dementia. Commonly ACP is completed in the last six months of life but in dementia there may be problems with this as decision-making capacity and ability to communicate necessarily decrease as the disease progresses. Choosing the right time to discuss ACP with people with dementia may be challenging given the duration of the illness may be up to nine years.AimsTo explore the acceptability of discussing ACP with people with memory problems and mild dementia shortly after diagnosis.MethodsIn-depth interviews were conducted with 12 patients and eight carers who had participated in ACP discussions and six staff members from a memory clinic and a community mental health team who had either conducted or attended the discussions for training purposes.ResultsPatients and carers found ACP a positive intervention that helped them think about the future, enabled people with dementia to make their wishes known, and resulted in their feeling relieved and less worried about the future. The importance of sharing the ACP documentation between health service providers was highlighted.ConclusionsThis qualitative evaluation of ACP in early dementia has encouragingly positive results which support the wider application of the intervention in memory services and community mental health teams. Strategies are suggested to support the implementation of ACP further in clinical practice.

show abstract

The effect of discussions about advance directives on patients’ satisfaction with primary care

Cited by 99 publications

References 27 publications

Literacy and Race as Risk Factors for Low Rates of Advance Directives in Older Adults

Literacy and Race as Risk Factors for Low Rates of Advance Directives in Older Adults

Advance Directives in Community Patients With Heart Failure

Qualitative Evaluation of Advanced Care Planning in Early Dementia (ACP-ED)

Contact Info

Product

Resources

About