THE DOCTORS ROLE IN DISCUSSING ADVANCE PREFERENCES FOR END-OF-LIFE CARE - PERCEPTIONS OF PHYSICIANS PRACTICING IN THE VA

OBJECTIVES: Although previous studies have shown physicians support ad vance directives, little is known about how they actually participate in decision-making. This study investigates (1) hew much experience ph ysicians have had discussing and following advance preferences and (2) how physicians perceive their role in the advance decision-making pro cess. DESIGN: Mail survey conducted in 1993. SETTING: The Department o f Veterans Affairs. PARTICIPANTS: A national probability sample of 105 0 VA internists, family physicians, and generalists. MEASUREMENTS AND MAIN RESULTS: Questionnaires were returned by 67% of participants. In the last year, 79% stated they had discussed advance preferences with at least one patient, and 19% had talked to more than 25. Seventy-thre e percent had used a written directive to make decisions for at least one incompetent patient. Younger age, board certification, spending le ss time in the outpatient setting, and personal experience with advanc e decision-making, were all associated independently with having advan ce preference discussions. Among physicians who had discussions, 59% s aid they often initiated the discussion, 55% said discussions often oc curred in inpatient settings, and 31% said discussions often occurred in outpatient settings. Eighty-two percent of those responding thought physicians should be responsible for initiating discussions. Most wou ld try to persuade a patient to change a decision that was not well in formed (91%), not medically reasonable (88%), or not in the patient's best interest (88%); few would attempt to change decisions that confli cted with their own moral beliefs (14%). CONCLUSIONS: Physicians repor t that they are actively involved with their patients in making decisi ons about end-of-life care. Most say they have had recent discussions with at least some of their patients and feel that as physicians they should play a large and important role in soliciting and shaping patie nt preferences.