CANADIAN OUTPATIENTS AND ADVANCE DIRECTIVES - POOR KNOWLEDGE AND LITTLE EXPERIENCE BUT POSITIVE ATTITUDES

Objective: To examine the knowledge of, previous experience with, atti tudes toward and perceived barriers to completing advance directives a mong outpatients at two general medicine clinics. Design: Cross-sectio nal questionnaire administered in face-to-face structured interviews. Setting: General internal-medicine outpatient clinics at a university teaching hospital. Patients: One hundred and five adult outpatients wh o could communicate in spoken English and who consented to be intervie wed. Results: Of 167 patients approached, 58 were excluded because the y could not communicate in spoken English, and 4 refused to participat e. Of the remaining 105 patients, 17 (16%) knew about living wills, 12 (11%) about durable powers of attorney for health care and 4 (4%) abo ut advance directives. Twenty-three (22%) had thought about their pref erences for life-sustaining treatment, 20 (19%) had discussed them, no ne had written them down, and 45 (43%) had thought about choosing a pr oxy. Sixty-one (58%) wanted to think about their preferences for treat ment, 65 (62%) wanted to discuss them, 32 (30%) wanted to write them d own, and 80 (76%) wanted to choose a proxy. The perceived barriers to completing an advance directive were inability to write, the belief th at an advance directive was unnecessary, a fatalistic attitude, previo us discussion of preferences, a desire to leave the decision to doctor s, uncertainty about preferences, a desire to discuss preferences rath er than document them, a desire to wait until the situation arose, a d esire to write down preferences in the future and a desire to avoid th inking about preferences or advance directives. Respondents with more knowledge of life-sustaining treatments were more likely to want to co mplete an advance directive. Conclusions: Outpatients have positive at titudes toward advance directives, but their knowledge and experience are limited. These data underscore the need for patient education and for policies to eliminate the barriers to completing advance directive s that patients face.