Advance directive use among patients undergoing high-risk operations

Area of Science:

• Medical Ethics
• Surgical Patient Care
• Advance Care Planning

Background:

• The Patient Self-Determination Act mandates inquiry about advance directives upon hospital admission.
• Surgeons have historically shown limited focus on advance directive utilization in major surgical procedures.
• This study addresses the gap in understanding advance directive use among patients undergoing high-risk surgeries.

Purpose of the Study:

• To evaluate the prevalence and impact of advance directives in patients undergoing pancreaticoduodenectomy and esophagectomy.
• To assess the integration of advance directives into the medical records of surgical patients.
• To identify opportunities for enhancing patient autonomy in major surgical contexts.

Main Methods:

• Retrospective review of 252 patients undergoing pancreaticoduodenectomy or esophagectomy between 1996 and 2001.
• Data collection focused on the documented existence of advance directives and their influence on clinical decisions.
• Analysis of patient charts to determine the presence and impact of advance directives.

Main Results:

• A growing number of patients undergoing major surgery possessed advance directives.
• Despite increased prevalence, advance directives had minimal demonstrable impact on patient care decisions.
• The documentation of advance directives within medical records remained infrequent.

Conclusions:

• While awareness of advance directives has increased, their presence in medical records for major surgery patients is suboptimal.
• Enhanced attention to advance directives can significantly improve surgeon-patient communication.
• Promoting the use of advance directives is crucial for upholding and extending patient autonomy in surgical settings.