Advance Directives and Communication in Medical Care. Abstract, Executive Summaryand Final Report

摘要

This project studied the impact of executing an advance directive on healthstatus, costs, and benefit-costs utility and also studied patient-physician communication as facilitated by a quality of life instruction supplement and a procedure oriented instruction supplement. Two hundred twenty patients whose expected five year mortality rate was 50% or greater participated in the randomized prospective clinical trial. Fifty physicians were exposed to either one of the other of the two different instruction supplements. The authors are currently in the midst of analyzing their data. So far their results show that patients seem to have more difficulty responding to the quality of life questionnaire than to the procedure oriented questionnaire. Most respondents do not wish aggressive treatments when quality of life is poor but a small number of patients do. There was moderate correlation between responses to the two supplements with respect to treatment preferences. So far there were no differences between treatments and costs of patients whose physicians were exposed to either one or the other instruction supplement. In follow-up of previous observations, physicians seem to predict patients preferences for treatments under the influence of their own preferences.