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Poor Doctor Communication Can Negate End-of-Life Planning
- May 12th, 2003
When seriously ill patients are nearing the end of life, they and their families sometimes find it difficult to decide whether to continue medical treatment and, if so, how much treatment is wanted and for how long. In these instances, patients rely on their physicians or other trusted health professionals for guidance.
In the best of circumstances, the patient''s wishes regarding treatment have been set down in an advance medical directive known as a living will. This is a formal legal documents specifically authorized by state laws that provides instructions for care in case the patient becomes incapacitated and cannot make decisions. A medical directive may also be a health care proxy. This document allows the patient to designate a surrogate, a person who will make treatment decisions for the patient if the patient becomes too incapacitated to make such decisions.
But research by the Agency for Healthcare Research and Quality (AHRQ) indicates that most patients have not participated in advance care planning, even though many are willing to discuss end-of-life care. Less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record, and only 12 percent of patients with a medical directive had received input from their physician in its development
Moreover, AHRQ research found that even the existence of a medical directive is no guarantee that the patient''s wishes will be followed. Between 65 and 76 percent of physicians whose patients had a medical directive were not aware that it existed. It''s no surprise, therefore, that research shows that care at the end of life sometimes appears to be inconsistent with the patients'' preferences to forgo life-sustaining treatment, and patients may receive care they do not want.
According to the AHRQ, lack of communication between patients and physicians and other health care providers is a chief culprit. One AHRQ study indicated that about one-third of patients would discuss advance care planning if the physician brought up the subject and about one-fourth of patients had been under the impression that advance care planning was only for people who were very ill or very old. AHRQ-funded studies have shown that discussing advance care planning and directives with their doctor increased patient satisfaction among patients age 65 years and over.
An article on the findings, "Advance Care Planning: Preferences for Care at the End of Life," suggests processes that physicians can use to structure discussions with patients on end-of-life care.
For the AHRQ article, go to: http://www.ahrq.gov/research/endliferia/endria.htm
For more on medical directives, click here.
Local Elder Law Attorneys in Ashburn, VA
Needham Mitnick & Pollack, PLC
Susan Pollack served as Chairperson of the Falls Church Senior Citizens Commission from 1997 to 2011 and was on the Executive Board of the Falls Church Education Foundation. She has also served on the Board of Directors of the Alzheimer’s Association of the National Capital Area and is a member of the Arlington B...
Felinton Elder Law & Estate Planning Centers
Mindy Felinton concentrates in the areas of Medicaid planning, Veterans' Benefits, asset protection, nursing home planning, elder law, wills, estate planning, trusts, living wills, powers of attorney, probate administration and trust administration and began her legal career 30 years ago as an Assistant State Attorney...
Margaret A. O'Reilly, PC
Margaret A. O’Reilly is an estate planning and elder law attorney with over thirty-five years of legal experience. Attorney O’Reilly graduated from Duke University with a degree in psychology, and received her law degree from Northeastern University School of Law in Boston, Massachusetts. For over 15 y...