"They're going to unplug grandma": advance directive discussions and documentation do not decrease survival in...

Area of Science:

• Medical Ethics
• Palliative Care
• Health Services Research

Background:

• Advance directives (AD) are crucial for patient autonomy in healthcare decision-making.
• The impact of AD discussions and documentation on patient survival remains a subject of debate.
• Understanding potential mortality effects is vital for current advance care planning discussions.

Purpose of the Study:

• To investigate the effect of advance directive (AD) discussions and documented ADs on patient survival.
• To provide evidence regarding the safety of engaging patients in advance care planning.

Main Methods:

• A prospective observational cohort study was conducted with 458 adult patients.
• Patients were interviewed about AD discussions, and medical records were reviewed for AD documentation.
• Participants were stratified by 1-year mortality risk (low, medium, high), with survival analysis performed for low and medium-risk groups.

Main Results:

• No statistically significant differences in survival were observed between patients who had AD discussions and those who did not.
• Similarly, no significant survival differences were found between patients with an AD in their record and those without.
• Statistical analyses (Wilcoxon and log-rank tests) showed no adverse impact on survival for either AD discussions or documentation.

Conclusions:

• The study found no evidence that advance directive (AD) discussions or their documentation are associated with increased patient mortality.
• These findings suggest that encouraging and honoring patients' wishes for AD discussions and documentation does not lead to harm.
• This research supports the integration of advance care planning into routine medical practice without concerns about negative survival outcomes.