Documenting patients' end-of-life decisions.

Area of Science:

• Medical Ethics
• Patient Autonomy
• Healthcare Decision-Making

Background:

• Families face distress when making healthcare decisions for incompetent individuals.
• There is a need for effective methods to document patients' end-of-life wishes.
• Advance care planning is crucial for respecting patient autonomy.

Purpose of the Study:

• To explore the feasibility of using a "value history" questionnaire to record competent patients' end-of-life care preferences.
• To assess whether primary care physicians or nurse practitioners can efficiently gather this information.
• To determine patient willingness to document these wishes and preferred locations for data collection.

Main Methods:

• A "value history" questionnaire was administered to 400 patients.
• Interviews were conducted by primary care physicians and nurse practitioners.
• Data were collected on patient preferences regarding truth-telling, decision-making, life support, and preferred interview settings.

Main Results:

• Patients desire truthfulness and participation in their healthcare decisions, even when terminally ill.
• Most patients do not wish to be indefinitely sustained on life-support systems.
• Patient responses were consistent regardless of whether a physician or nurse practitioner conducted the interview.

Conclusions:

• A "value history" questionnaire is an effective tool for documenting patient end-of-life preferences.
• Both primary care offices and patients' homes are suitable settings for obtaining value histories.
• Value histories should be integrated into routine medical records to support informed end-of-life care decisions.