A new look at advance directives: Surprising number of patients request intervention

Patients who complete advance care directives want to be free of pain at the end of their lives, but many also request interventions such as antibiotics and breathing assistance, a new study published in The Journal of Medical Ethics found.

The study of 491 Texas patients ranging in age from 19 to 94 found that nearly one-third asked for medical intervention. Patients younger than 50 were more likely to request intervention, the study found, while patients older than 50 were more likely to refuse aggressive care. The proportion of patients requesting intervention was higher than found in previous studies.

"Contrary to common beliefs in the healthcare community, advance directives are used for more than refusing care," lead author Craig M. Klugman, who chairs the Department of Health Sciences at DePaul University, said in a study announcement. "However, many participants indicated that they had not yet had a meaningful conversation with their future surrogate decision-maker, and this needs to be addressed." 

Many patients said they had provided their advance directive to their lawyer or doctor, according to the findings, but "far fewer" talked about their wishes with loved ones.

Those findings are in contrast to a 2013 study in JAMA Internal Medicine that found a majority of elderly patients at a high risk of dying within six months had discussed their wishes with a family member, but not necessarily with their doctors. That study didn't specifically focus on advance directives.

Potentially muddying the waters is the growing number of patients without family or other advocates with whom to discuss end-of-life decisions. The demographics of the baby boom generation, including higher numbers of divorced and childless patients, means there are increasing numbers of "unbefriended" patients, FierceHealthcare previously reported. The aging population also means some patients have just outlived their support networks.

As a result, 24 states and the District of Columbia now allow close friends to speak for a patient and consent or decline medical treatment on his or her behalf. 

For more:
- here's the study abstract
- read the announcement
- see the JAMA Internal Medicine study