Roles of physicians, attorneys, and illness experience in advance directives

Age, illness severity, functional status, and education are associated with advance directive completion. We examined these patient characteristics and discussions with attorneys and physicians in a predictive model for advance directive completion.

We did a cross-sectional survey of 255 randomly selected patients in a VA outpatient clinic.

Patients were predominantly men (95.2%), married (61.9%), with a mean age of 63.2 years; 17.7% of the patients had an advance directive; 5.0% had only a living will, 6.0% had only a durable power of attorney for health care, and 6.7% had both. Age, marital status, illness severity, previous serious illness in spouse, and physician discussion were all associated with advance directive completion in a multiple logistic regression. Eighty-two patients were asked about discussions with attorneys--15 had advance directives; of these, 13 had talked to an attorney, but only 7 had talked to a physician.

Previous serious spousal illness, marital status, age, illness severity, and patient-physician discussions all predicted completions of an advance directive. Attorney discussions were strongly associated with advance directive completion. Better communication between physicians, patients, and attorneys may increase the usefulness of advance directives.