Advance directives are a document in which one’s wishes concerning medical treatment at the end of life are recorded.The most common advance directives are living wills and durable powers of attorney. According to a study published in the April 1, 2010 issue of the New England Journal of Medicine, advance directives are effective in ensuring that patients’ preferences regarding medical care are observed at the end of life.

Researchers from the University of Michigan and their colleagues sought to evaluate the value of advance directives. Using data from the Health and Retirement Study involving adults aged 60 and over, the researchers analyzed 3,746 people in order to determine the prevalence of the need for decision making, as well as the effectiveness of advance directives. The researchers found that 42.5 percent of patients were faced with treatment decisions near the end of their lives, but more than 70 percent of these people lacked the ability to make choices about their medical care due to deterioration in their physical or mental health. However, among those who were faced with treatment decisions, the majority (67.6%) had advance directives.

The researchers found that people who had advance directives were more likely to want limited care or comfort care than aggressive measures. They also found the instructions documented in the advance directives were nearly always carried out by healthcare proxies or surrogate decision-makers. Of the patients who requested limited care in their advance directives, 83.2 percent received it. Of the patients who requested comfort care, 97.1 percent received care consistent with their preferences.

In the early 1990s, studies reported that only 20 percent of people had advance directives. Based on the findings of this study, more people are making use of advance directives in order to document their preferences for end-of-life care.  And, people with advance directives typically receive care that is strongly associated with their preferences. According to the study authors, these findings support the continued use of advance directives.

Source:

NEJM. 2010;362:1211-1218.