Elderly Outpatients' Understanding of a Physician-Initiated Advance Directive Discussion

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OBJECTIVE: To examine elderly outpatients' understanding of advance directives (ADs), cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration (ANH) with and without the benefit of a physician-initiated discussion.

DESIGN: Randomized controlled trial.

SETTING: University-affiliated, community-based, urban family practice residency training program.

PATIENTS: One hundred patients aged 65 and older, consecutively sampled and randomly assigned to one of two discussion groups.

INTERVENTIONS: Physicians' discussions based on a prepared script consisting of AD issues or health promotion issues.

MAIN OUTCOME MEASURES: Test of comprehension of AD, CPR, and ANH information, using open-ended and yes-or-no questions.

RESULTS: Patients in the AD and health promotion discussion groups showed good basic understanding. Younger and better-educated patients had a better working knowledge of AD-related information. Understanding of ADs was higher when the physician spent more time talking about AD-related issues after the discussion was completed.

CONCLUSIONS: Many elderly outpatients have a good basic understanding of ADs, CPR, and ANH, even without explicit explanations from physicians. However, younger, better-educated patients and those who had longer unstructured discussions had greater AD-related knowledge. These factors need to be considered when framing discussions with patients about ADs and life-sustaining treatments.

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Archives of Family Medicine, v. 3, no. 12, p. 1057-1063