Elderly Outpatients' Understanding of a Physician-Initiated Advance Directive Discussion
Kathleen A. Moore, MA;
Joseph H. Danks, PhD;
Peter H. Ditto, PhD;
Jennifer A. Druley, MS;
Aloen Townsend, PhD;
William D. Smucker, MD
Arch Fam Med. 1994;3(12):1057-1063.
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 physicianinitiated discussion.
Randomized controlled trial.
University-affiliated, community-based, urban family practice residency training program.
One hundred patients aged 65 and older, consecutively sampled and randomly assigned to one of two discussion groups.
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.
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.
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.
From the Department of Psychology, Kent (Ohio) State University (Mss Moore and Druley and Drs Danks, Ditto, and Townsend), and the Family Practice Center of Akron (Ohio), Summa Health System (Dr Smucker).
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