CAN WE TALK - INPATIENT DISCUSSIONS ABOUT ADVANCE DIRECTIVES IN A COMMUNITY-HOSPITAL - ATTENDING PHYSICIANS ATTITUDES, THEIR INPATIENTS WISHES, AND REPORTED EXPERIENCE

Background: The attitudes of hospitalized patients and their attending physicians about advance directives have not been well studied. We co mpared these attitudes and explored relationships between them and the frequency of actual directives and directive discussions during hospi talization. Methods: We conducted scripted interviews with 258 (94.5%) of 273 patients admitted consecutively to the acute medical service o f a community teaching hospital in Rochester, NY, and contemporaneousl y surveyed their attending physicians (n=68) regarding attitudes about advance directives. Primary outcome measures were patients' willingne ss to discuss directives, actual physician-patient directive discussio ns, and patients' preferences for life-sustaining treatments. Also mea sured were physicians' indications for directive discussions, their re asons not to discuss directives, and their knowledge and attitudes abo ut life-sustaining treatments. Results: Eighty-one percent (172/212) o f competent interviewed patients either did (100) or wanted to (72) di scuss advance directives in hospital. Forty-one percent of patients ch ose to forgo cardiopulmonary resuscitation; 24% to 41% refused other l ife-sustaining interventions (intensive care unit admission, mechanica l ventilation, cardioversion, vasopressors). Overall, 90% (246/273) of all patients met at least one of three criteria reported by their phy sicians as indications for advance directive discussions: age at least 75 years, critical or potentially fatal illness, and patients' desire to discuss directives. Multiple logistic regression revealed that the se same variables predicted patients' willingness to discuss cardiopul monary resuscitation, their preferences to receive or forgo cardiopulm onary resuscitation, and the frequency of physician-patient discussion s about these issues. Conclusions: Most medical inpatients in a commun ity hospital want to, are able to, and meet their own physicians' indi cations to discuss advance directives. Hospitalization presents an unr ealized opportunity for physicians and patients to initiate these disc ussions.