ADVANCE DIRECTIVE DECISION-MAKING AMONG MEDICAL INPATIENTS

Per the Patient Self-Determination Act of 1991, hospitals are required to ascertain whether patients have an advance directive (AD), At this point, factors prompting patients to issue ADs have not been studied, The purpose of this study was to describe patients' understanding of ADs as well as the process patients used to arrive at their decisions to implement an AD, A stratified random sample of 26 patients from two intensive care units, one general medical unit, one general cardiac u nit, and one acquired immunodeficiency unit were selected for particip ation, Patients were asked a series of open-ended questions to determi ne their knowledge and understanding of ADs, The constant comparative method was used to review the transcripts, It was found that only 31 p er cent of patients had issued an AD, and 20% had learned of ADs for t he first time during their hospitalization. Response analysis showed f our phases of AD decision making: evaluation of illness, establishment of priorities, consideration of implications of the directives, and s election or rejection of directives, In conclusion, patients continue to have limited understanding of ADs and their implications, Continued investigation will elucidate the best strategies to educate patients about this topic. (C) 1996 by W. B. Saunders Company