Advance directives: ambulatory patients' knowledge and perspectives

Background

There is a growing awareness of the need for discussion of advance directives (ADs) in the ambulatory setting, but rates of completion remain low. Clarification of patients’ perceptions and knowledge would help in designing future strategies.

Methods

This is a prospective study of adult ambulatory patients at four academic internal medicine clinical sites at the University at Buffalo during a 6-week period in 2004. We obtained data using a standard instrument administered by a research assistant. The data included demographic variables, patients’ awareness of and familiarity with specific ADs, and whether the patient had any ADs. Patients also were asked about attitudes concerning the appropriateness of ADs. We performed multivariate logistic regression on the variables.

Results

Of 508 patients, 86.2% were unfamiliar with the term “advance directives,” but 93.5% were familiar with one or more specific kinds of ADs. Some 43.1% of patients claimed to have completed an AD, but of those who said they had, only 25% thought their provider had a copy. Multivariate logistic regression demonstrated significant correlation between having completed an AD and age, reading ability, and educational level (all P < .001).

Conclusions

A large number of patients in an ambulatory internal medicine practice knew about ADs and believed they had completed such documents, but these documents were often not in the chart. Many patients believe discussions of ADs are not appropriate for them. A better understanding of this phenomenon will help in promoting effective advance care planning.