Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

End-of-life Treatment Decisions and Patients’ Advance Directives

28.07.2004


In a study using hypothetical cases, physicians commonly made end-of-life treatment decisions that were not consistent with patient preferences stated in explicit advance directives, according to an article in the July 26 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to background information in the article, significant concern remains about how well physicians know and follow the treatment preferences of their patients. Decisions are particularly problematic for critically ill and dying patients who lose their capacity to make medical decisions. A variety of factors may influence treatment decisions – including the probability of survival or recovery, and perceived quality of life. While advance directives have been widely promoted as a means to ensure that patients’ treatment preferences are followed, there is limited evidence that they actually accomplish this purpose.

Steven B. Hardin, M.D., and colleagues with the Jerry L. Pettis Memorial Veterans Affairs Medical Center and Loma Linda University School of Medicine, Loma Linda, Calif., devised a survey of six hypothetical cases describing patients with serious or life-threatening illnesses who had lost their decision-making capacity. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. The study participants were all internal medicine faculty and resident physicians from Loma Linda University Medical Center and affiliated hospitals.



Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Of the 250 surveys mailed, 117 analyzable surveys were returned from 77 faculty and 40 resident physicians.

“Despite the presence of an explicit advance directive, physicians frequently made treatment decisions contrary to documented patient preferences,” the authors report.

In 65 percent of cases, decisions by faculty and residents were not consistent with the advance directive. This inconsistency was similar for faculty (68 percent of cases) and residents (61 percent of cases). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions.

“In difficult clinical situations, internists appear to consider other factors such as prognosis, perceived quality of life, and the wishes of family or friends as more determinative than the directive,” the authors write.

The authors point out that advance directives have helped to encourage physicians and patients to start conversing about treatment decisions. But they assert that the limitation of advance directives illustrates the need for more effective conflict resolution when patients, family, and staff disagree about treatment choices.

“Continuing improvement in the process of end-of-life decision making is needed,” the authors conclude. “This process will have to recognize the inherent uncertainties in caring for seriously ill patients.”

| newswise
Further information:
http://www.ama-assn.org

More articles from Health and Medicine:

nachricht Collagen nanofibrils in mammalian tissues get stronger with exercise
14.12.2018 | University of Illinois College of Engineering

nachricht New discoveries predict ability to forecast dementia from single molecule
12.12.2018 | UT Southwestern Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Data use draining your battery? Tiny device to speed up memory while also saving power

The more objects we make "smart," from watches to entire buildings, the greater the need for these devices to store and retrieve massive amounts of data quickly without consuming too much power.

Millions of new memory cells could be part of a computer chip and provide that speed and energy savings, thanks to the discovery of a previously unobserved...

Im Focus: An energy-efficient way to stay warm: Sew high-tech heating patches to your clothes

Personal patches could reduce energy waste in buildings, Rutgers-led study says

What if, instead of turning up the thermostat, you could warm up with high-tech, flexible patches sewn into your clothes - while significantly reducing your...

Im Focus: Lethal combination: Drug cocktail turns off the juice to cancer cells

A widely used diabetes medication combined with an antihypertensive drug specifically inhibits tumor growth – this was discovered by researchers from the University of Basel’s Biozentrum two years ago. In a follow-up study, recently published in “Cell Reports”, the scientists report that this drug cocktail induces cancer cell death by switching off their energy supply.

The widely used anti-diabetes drug metformin not only reduces blood sugar but also has an anti-cancer effect. However, the metformin dose commonly used in the...

Im Focus: New Foldable Drone Flies through Narrow Holes in Rescue Missions

A research team from the University of Zurich has developed a new drone that can retract its propeller arms in flight and make itself small to fit through narrow gaps and holes. This is particularly useful when searching for victims of natural disasters.

Inspecting a damaged building after an earthquake or during a fire is exactly the kind of job that human rescuers would like drones to do for them. A flying...

Im Focus: Topological material switched off and on for the first time

Key advance for future topological transistors

Over the last decade, there has been much excitement about the discovery, recognised by the Nobel Prize in Physics only two years ago, that there are two types...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

ICTM Conference 2019: Digitization emerges as an engineering trend for turbomachinery construction

12.12.2018 | Event News

New Plastics Economy Investor Forum - Meeting Point for Innovations

10.12.2018 | Event News

EGU 2019 meeting: Media registration now open

06.12.2018 | Event News

 
Latest News

Data use draining your battery? Tiny device to speed up memory while also saving power

14.12.2018 | Power and Electrical Engineering

Tangled magnetic fields power cosmic particle accelerators

14.12.2018 | Physics and Astronomy

In search of missing worlds, Hubble finds a fast evaporating exoplanet

14.12.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>