Advance directive use among patients undergoing selected high-risk surgical procedures

Since 1991, the Patient Self-Determination Act has required that all patients entering Medicare-reimbursed institutions be asked if they have an advance directive (AD) and be given information about advance directives if they do not have one. Patients undergoing elective high-risk surgery for diseases with a poor prognosis were identified as being most likely to benefit from an AD. The charts of patients being explored for possible pancreaticoduodenectomy or esophagectomy at a tertiary referral hospital in 1996 were retrospectively reviewed. Few patients had an AD, and there was little evidence that the presence of an AD affected patient care.