April 6, 2010
This study was conducted as a randomized clinical trial in Melbourne Australia on patients 80 years or older. About half of the 300 patients were in either the experimental or control group.
The second study appeared about a week later in the New England Journal of Medicine on April 1, 2010. This retrospective study entitled “Advance Directives and Outcomes of Surrogate Decision Making before Death,” involved nearly 3,800 seniors who died between 2000 to 2006 in the US, and for whom a patient representative was able to answer a series of questions about the decision making prior to the death.
The study concluded “both a living will and a durable power of attorney for health care appear to have a significant effect on the outcomes of decision making. Thus, advance directives are important tools for providing care in keeping with patients’ wishes. For more patients to avail themselves of these valuable instruments, the health care system should ensure that providers have the time, space, and reimbursement to conduct the time consuming discussions necessary to plan appropriately for the end of life. Data suggest that most elderly patients would welcome these discussions.”
What’s good about both of these studies is that they come at a time of growing awareness among consumers that redirecting goals of care may actually improve the outcome and satisfaction for patients who are dealing with advanced disease, increasing debility and frailty and a growing skepticism that more is better in US healthcare.
They also underscore the fact that advance care planning helps – despite recent claims otherwise.
Labels: aging and end of life; advance directives; bioethics; durable power of attorney for healthcare decisions; medical ethics