Patient perception on the use of advance directives and life prolonging technology

Introduction: Use of advance directives in advance care planning is underutilized despite the Patient Self Determination Act of 1990. This study was undertaken to determine the use and opinions of advance directives by patients at a multidisciplinary clinic in a residency training program.

Methods: IRB approved, prospective survey of patients age 18 and over presenting in October 2005.

Results: Of 306 subjects, 77 (25.2%) subjects had a durable power of attorney and 45 (14.7%) had a living will. Of the entire cohort, 116 (37.9%) agreed they would not want life support, while 74 (24.2%) agreed they would want any measure used to keep them alive for as long as possible. A total of 226 (73.9%) responded that it was important to make their healthcare wishes known to their doctor, however, only 36 (15.9%) had actually done so. A total of 266 (86.9%) felt it was important to discuss their healthcare wishes with their family and only 160 (60.1%) had initiated these conversations. The average age of respondents with a durable power of attorney and/or living will, and who had spoken to their physician or family about their wishes was significantly older when compared to those who had not done these things (p < 0.001).

Conclusions: While adequately describing use of, and attitudes toward, advance directives, it is significant to note that while most patients believe that their wishes for end of life care will be honored, they fail to take the necessary steps to guarantee that this will occur.