Journal of general internal medicine
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Randomized Controlled Trial Clinical Trial
Role of written advance directives in decision making: insights from qualitative and quantitative data.
To understand the role of written advance directives (ADs) in medical decision making through examination of qualitative and quantitative data sources. We specifically wanted to address whether physicians unilaterally disregard advance directives. ⋯ Our findings indicate that physicians are not unilaterally disregarding patients' ADs. Despite the patients' serious illnesses, family members and physicians did not see them as "absolutely, hopelessly ill." Hence, ADs were not considered applicable to the majority of these cases. Cases in which ADs had an impact evidenced open negotiation with a surrogate that yielded a transition in the goals of care.
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To determine patient knowledge about life-sustaining treatments and physician understanding of patient preferences for proxies and treatments after outpatient discussions about advance directives. ⋯ Patients leave routine AD discussions with serious misconceptions about life-sustaining treatments. Physicians are unable to predict treatment preferences but do learn about patients' preferences for surrogate decision makers.