Few patients have an advance directive in place, according to a new study, which calls on the healthcare industry to address common barriers to completing the documents.
A review of studies conducted between 2011 and 2016 suggests that just one-third of of U.S. adults have some kind of advance directive established, according to research published in Health Affairs. The study included data on nearly 800,000 people, and about 36% had completed some kind of advance directive, including living wills.
The findings were consistent across the years included in the review. The rates were close between adults with chronic conditions (about 38%) and otherwise healthy patients (about 33%), according to the study.
The study offers a baseline for the healthcare industry to use when developing initiatives to increase the number of patients with advance directives, the research team, which includes experts at the University of Pennsylvania, Boston Medical Center, Thomas Jefferson University and Princeton, concluded.
“Because advance directives remain a key component of high-quality advance care planning, increasing their completion rates remains a national priority,” they wrote. “Specifically, policies and interventions should focus on populations with low advance directive prevalence rates and at high risk for poor end-of-life care outcomes.”
Meanwhile, Amber Barnato, M.D., a professor of healthcare delivery at Dartmouth College’s Institute for Health Policy and Clinical Practice, wrote in a second Health Affairs article that providers can better ensure that they’re following patients’ wishes by checking their own practice norms. The way individual doctors, practices or hospitals interpret advance directive or patients’ requests can influence their choices, she wrote.
While it won't fully remove the influence providers have in patient decision-making, it can help reduce it if they are aware of the issue and take a systemized approach to advance care planning. Gather feedback to assess how strongly local practice norms play into these conversations and try coaching for a change of approach, Barnato wrote.
Providers also need to be able to better recognize when it’s time for tough conversations about end-of-life care, she said, and these discussions may be too focused on the biomedical elements of treatment, which may not align with the patient’s goals.
“In the vast majority of meetings, there were no conversations about the patient’s values regarding autonomy and independence, emotional well-being and relationships, physical function, cognitive function, or spirituality—concerns that seriously ill patients identify as being most important to them at the end of life,” Barnato said.