Development of a framework to encourage addressing advance directives when resources are limited

Advance directives are used to increase autonomy in decisions regarding care when a person lacks the ability to communicate such wishes. Based on studies showing internal consistency in individuals' preferences, this study demonstrates a new method for identifying a list of questions that may best predict patient preferences.

Participants were 71 residents of a large nursing home and 97 hospital patients. All were administered the Preferences for Life-Sustaining Treatment Questionnaire. Advance directives sequence models were developed using conditional probabilities concerning preferences for utilization of specific treatment options, given prior responses to different treatment options.

Models resulted in more than 90% accuracy of treatment preferences for both samples and eliminated two thirds to three quarters of questions asked.

Although the specific models need validation using larger samples, they demonstrate a method that facilitates transfer of information concerning treatment preferences if future incapacitation occurs.