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Related Experiment Videos

Implementing advance directives in the primary care setting

L J Markson1, J Fanale, K Steel

  • 1Geriatrics Section, Evans Memorial Department of Clinical Research, Boston, MA.

Archives of Internal Medicine
|October 24, 1994
PubMed
Summary
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Physician training and administrative support significantly increased advance directive completion rates in elderly patients. Practical experience, not just legal education, is key for physicians to integrate advance decision-making into primary care.

Area of Science:

  • Geriatric Medicine
  • Healthcare Policy
  • Medical Education

Background:

  • Advance directives are crucial for patient autonomy but are underutilized.
  • Barriers to advance decision-making persist, particularly in primary care settings.
  • Physician-led interventions are being explored to improve advance directive completion.

Purpose of the Study:

  • To assess the effectiveness of a combined educational and administrative intervention for physicians.
  • To determine if physicians can overcome barriers to discussing advance directives with elderly patients.
  • To evaluate the impact of practical training on physician behavior regarding advance decision-making.

Main Methods:

  • A 5-week legal training course on advance directives was provided to primary care internists in home care (HC) and nursing home (NH) services.
Keywords:
Death and EuthanasiaEmpirical ApproachNew York City

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  • Administrative support allowed physicians extra time for patient discussions.
  • The intervention was modified to include all active patients and practical training, including observed and led discussions.

    • Main Results:

    • Physicians successfully approached and facilitated advance directive completion in a significant percentage of eligible patients (65% in HC, 90% in NH).
    • Relatives were commonly chosen as proxies, and patients frequently directed withholding of life-sustaining treatments.
    • High completion rates were achieved, indicating patient willingness to engage in advance decision-making when prompted by physicians.

    Conclusions:

    • Physician reluctance to discuss advance directives can be overcome with targeted interventions.
    • Practical experience and observed discussions are more effective than legal education alone in changing physician behavior.
    • A physician-directed intervention is sufficient to achieve high rates of advance directive completion among elderly patients.