Impact of Advance Directives and a Health Care Proxy on Doctors' Decisions: A Randomized Trial

Abstract

Advance directives and proxy opinions are equally effective in influencing doctors' decisions, but having both has the strongest effect. The format of the advance directive and the identity of the proxy have little influence on decisions.

Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis

“…In support of this interpretation, a small clinical trial recently demonstrated that patients with ESRD who engaged in an advance care planning intervention with their surrogate were twice as likely to discontinue dialysis compared with patients who did not receive the intervention (3). In our study, the separate contributions of surrogates and treatment-limiting directives seemed to be mutually reinforcing in most situations (32). At the same time, the presence of a surrogate was associated with a higher likelihood of receiving care that was discordant with a treatmentlimiting directive.…”

Has there been a change in the end-of-life decision-making over the past 16 years?

“…In the analysis, the responders in 2015 were more willing to give a voucher than the responders in 1999. advance directives genuinely express a patient's own will. [24,25] When two short-term goals (meeting the son or a minister in the next few days) and a suspicion of iatrogenic bleeding were presented, the proportion of the physicians choosing a palliative care approach decreased, but significantly less in 2015 than in 1999. These scenarios forced the responding physicians to make ethically demanding decisions.…”

Making medical decisions for an incompetent older adult when both a proxy and an advance directive are available: which is more likely to reflect the older adult’s preferences?

“…Family wishes also impact medical decisions, although responsiveness to their wishes has been found to be associated with providers’ characteristics (eg, age, self-confidence regarding knowledge of medical ethics and working environment) 7 9. In a recent survey among Swiss doctors, Escher et al 6 found advance directives and relatives’ opinions to equally influence doctors’ hypothetical decision to provide treatment that could benefit a fictional patient. To our knowledge, however, no study has yet investigated which of these two sources of information is closer to what the patient would have wanted in the circumstances had he or she been able to make a decision.…”