Background: Although advance medical directives, such as living wills
and durable powers of attorney for health care, are by themselves impe
rfect instruments for expressing patients' treatment preferences, a po
ssible benefit of these documents is that they will enhance patient-ph
ysician communication, especially when end-of-life treatment decisions
have to be made. Method: Structured interviews were completed for 115
seriously ill cancer patients and 22 of their physicians. The questio
ns dealt with various aspects of advance directives, including communi
cations between the two parties regarding general and specific treatme
nt wishes. dispenses were compared in 37 physician-patient pairs for p
atients who had executed advance directives and in 31 physician-patien
t pairs for patients who had not executed advance directives. Results:
Physicians were frequently unaware of their patients' advance directi
ves. Although patients with advance directives were marginally more li
kely than patients without advance directives to report discussions ab
out end-of-life treatment decisions, only 34 (30%) out of the total of
115 patients claimed that they had any discussion of treatment decisi
ons with their physicians. Such discussions tended to be about general
life attitudes and feelings rather than specific treatments, such as
use of artificial nutrition or ventilation. Conclusion: Despite public
enthusiasm for the use of advance directives and great efforts to pro
mote them, we found little evidence that these documents are associate
d with enhanced communication between patients and physicians about en
d-of-life treatment decisions.