ADVANCE DIRECTIVES IN UTAH - INFORMATION FROM DEATH CERTIFICATES AND INFORMANTS

Background: Advance directives have been studied in different patient populations and institutions. Most reports have shown limited use and little medically observable effect. To our knowledge, no previous stud y has focused on the use of advance directives by individuals who have died or how their family members perceived the documents' effect. Met hods: We contacted informants listed on Utah Death Certificates horn 1 992 to estimate the prevalence and effect of advance directives. Eight y-two percent of 1398 informants we contacted agreed to our telephone interview. Results: More than 50% of decedents reportedly completed an advance directive. Individuals older than 65 years (57.3%), women (58 .1%), nursing home residents (63.4%), and hospice users (75.2%) were m ost residents to have had advance directives. Education, religion, rel igiosity, and location had no effect on prevalence. Most informants st ared that advance directives had no effect on the decedent's care, but a minority felt they helped to limit treatment. Do-not-resuscitate or ders were written more often for patients with advance directives. Fee ding tubes were removed more often from decedents with living wills th an from other decedents. Mechanical ventilatory support was not less f requent in patients with advance directives. Conclusions: Our study co nfirms others that found little evidence that advance directives affec t life-sustaining treatments. In the infrequent situations when they a pply, they may be more persuasive than family members in convincing ph ysicians to limit treatment. We observed that survivors had 2 percepti ons about advance directives, not emphasized in previous reports, that they seemed to limit treatment and to ease their burden of decision m aking.