THE DISCUSSION ABOUT ADVANCE DIRECTIVES - PATIENT AND PHYSICIAN OPINIONS REGARDING WHEN AND HOW IT SHOULD BE CONDUCTED

Background: Widely publicized court cases have focused national attent ion on the importance of advance directives. In spite of initiatives s uch as the Patient Self-Determination Act of 1991, fewer than 10% of A mericans have prepared advance directives. One way to increase the pre paration of advance directives may be to increase the frequency and qu ality of discussions about them between individual patients and their physicians. We performed a multicenter observational study to assess t he opinions of primary care patients and physicians regarding these di scussions. Methods: This was a cross-sectional descriptive survey of r andomly randomly selected primary care patients and physicians in eigh t primary care internal medicine clinics in the eastern and midwestern United States. Quantitative questionnaires were used to elicit subjec ts' demographic characteristics, and their opinions regarding the timi ng, content, and location of discussions about advance directives. Res ults: The 883 subjects included 329 adult outpatients, 282 resident ph ysicians, and 272 practicing physicians. Physician and patient respons e rates were 75% and 76%, respectively. Patients felt that the discuss ion should occur earlier than did the physicians: at an earlier age, e arlier in the natural history of disease, and earlier in the patient-p hysician relationship. Most subjects agreed it was the physician's res ponsibility to initiate the discussion. Conclusion: We defined a discr epancy between the preferences of primary care patients and physicians regarding the timing of the discussion about advance directives. We p ropose physician education regarding patient preferences as the most e ffective way to accomplish the goal of improving the frequency and qua lity of discussions about advance directives.