ATTITUDES REGARDING ADVANCE DIRECTIVES AMONG PATIENTS IN PULMONARY REHABILITATION

We performed a cross-sectional, descriptive questionnaire study in two pulmonary rehabilitation programs to assess: (1) attitudes of 105 sub jects with chronic lung conditions about end-of-life decisionmaking; ( 2) the determinants of these attitudes; and (3) patient acceptance of rehabilitation programs as foci for education about advance directives (ADs). We found that 99 of the 105 subjects (94.3%) had health worrie s, the most common of which was fear of increasing dyspnea (33.3%). Al though 93.8% had opinions about intubation, less than 42% had complete d an AD. Most subjects wanted information about ADs (88.6%) and life-s upport (68.6%); pulmonary rehabilitation programs, lawyers, and physic ians were preferred sources for AD information. Although 98.9% of the patients wanted patient-physician AD discussions, only 19.0% had such discussions, only 15.2% had discussed life-support, and only 14.3% tho ught that their physicians understood their end-of-life wishes. Subjec t willingness to undergo intubation varied with baseline health, likel ihood of survival, and anticipated health following extubation. We con clude that patients in pulmonary rehabilitation programs desire more i nformation about end-of-life issues than is currently provided by phys icians. They regard pulmonary rehabilitation educators as valuable sou rces of AD education.