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.
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 physicianinitiated 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.
Author Affiliations
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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