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Related Experiment Videos

Advance care planning.

Russ C Kolarik1, Robert M Arnold, Gary S Fischer

  • 1Division of General Internal Medicine and General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa, USA. kolarikrc@msx.upmc.edu

Journal of General Internal Medicine
|September 6, 2002
PubMed
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Patients found both values-based and treatment-based advance directives (AD) favorable. Treatment-based ADs offered a greater sense of control, while values-based ADs increased surrogate designation. Neither form alone prompted physician discussions.

Area of Science:

  • Gerontology
  • Medical Ethics
  • Health Services Research

Background:

  • Advance directives (AD) are challenging to implement when specifying exact treatments.
  • Values-based ADs focusing on patient goals and values are an advocated alternative.
  • Comparing patient responses to different AD formats is crucial for improving end-of-life care planning.

Purpose of the Study:

  • To compare patient reactions to values-based versus treatment-based advance directive forms.
  • To assess patient preferences and experiences with different AD formats.
  • To inform the development of more effective advance care planning tools.

Main Methods:

  • A randomized study involving outpatients aged 55+ at two academic general medicine clinics.
  • Participants completed either Emanuel's Medical Directive (EMD) or Pearlman's values history (PVH) form.
Keywords:
Empirical ApproachProfessional Patient Relationship

Related Experiment Videos

  • Data collected included completion time, questions asked, discussions, surrogate designation, and patient ratings via telephone interviews.

    • Main Results:

    • Both EMD and PVH forms were generally well-received, with 92% and 84% agreement, respectively, on being a good first step in end-of-life care planning.
    • Patients using the EMD reported a greater sense of control over end-of-life care (84%) compared to PVH (48%).
    • The PVH form led to higher rates of surrogate designation (100%) versus EMD (79%), though EMD users worried more about form rigidity.

    Conclusions:

    • Both values-based and treatment-based ADs are viewed favorably by patients.
    • Treatment-based directives may enhance patient perceived control, while values-based directives facilitate surrogate designation.
    • While patients discuss ADs with family, neither form independently promotes physician engagement in advance care planning.