TRIAD I-The Realistic Interpretation of Advanced Directives

TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders

“…† Improvement in responses. (12). Our nationwide results further suggest that most physicians misinterpret a living will as a DNR designation and associate DNR orders with comfort care/ end-of-life care.…”

“…Several published case studies have demonstrated that language in living wills is often vague or poorly defined (11,12). Evidence from other institutions reveals that there are vast differences in the understanding of living wills among patients, family members, and physicians.…”

“…The Realistic Interpretation of Advance Directives (TRIAD I) study identified that the majority of living wills presented to various health care providers were incorrectly interpreted as synonymous to DNR orders (89% Emergency Medical Services, 79% nurses, 64% physicians) (12). These results prompted further investigation of living wills, specifically among pre-hospital providers (TRIAD II) (14).…”

A Living Will Misinterpreted as a DNR Order: Confusion Compromises Patient Care

“…Therefore, regardless of Mr. S.'s DNR status, EMS activation and transfusion of blood products would have been appropriate. Misinterpretation of advance directives is an emerging and troubling problem (2). Recent surveys of physicians, nurses, and EMS providers demonstrated that a significant percentage of providers at all levels interpreted a valid (but not enacted) living will as an order not to resuscitate (2).…”

TRIAD II: Do Living Wills Have an Impact on Pre-Hospital Lifesaving Care?

“…In comparison, 79% of nurses and 64% of doctors incorrectly designated the code status for the hypothetical patient as DNR. Also, 94% of EMS responders in the study indicated their understanding of DNR to mean comfort or end-of-life care (12).…”