Elderly outpatients' understanding of a physician-initiated advance directive discussion

Abstract

Objective: 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 physician-initiated discussion.

Design: Randomized controlled trial.

Setting: University-affiliated, community-based, urban family practice residency training program.

Patients: One hundred patients aged 65 and older, consecutively sampled and randomly assigned to one of two discussion groups.

Interventions: 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.

Results: 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.

Conclusions: 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.