“They're going to unplug grandma”: Advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death

Authors

  • Stacy M. Fischer MD,

    Corresponding author
    1. Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
    • Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, 13611 E Colfax Ave, Suite 100, Aurora, CO 80045
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    • Telephone: 303-514-0548; fax: 303-724-2530

  • Sung-Joon Min PhD,

    1. Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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  • Angela Sauaia MD, PhD,

    1. University of Colorado School of Public Health, Aurora, Colorado
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  • Jean S. Kutner MD, MSPH

    1. Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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  • Abstract presented at Society of General Internal Medicine meeting, Minneapolis, Minnesota, 2010.

    Funding for this study came from the Brookdale Leadership in Aging Fellowship Program and the National Institutes of Aging K23 AG028957-02. Disclosures: The authors have no conflicts of interest and no financial relationships with funding sources.

Abstract

OBJECTIVE:

To determine the effect of having advance directive (AD) discussions or having an AD in the medical record on patient survival.

DESIGN:

Prospective observational cohort study.

SETTING:

Three Colorado area hospitals: a large academic tertiary referral center, a Veteran's Affairs medical center, and an urban safety net hospital.

PARTICIPANTS:

Four hundred fifty-eight adults admitted to the general internal medicine service interviewed about AD discussions. A concurrent chart review documented the presence of an AD in the medical record. Participants were stratified into low, medium, and high risk of death within 1 year based on validated prognostic criteria.

MEASURES:

Kaplan-Meier survival plots were estimated for those at low and medium risk of death.

RESULTS:

No significant differences in survival for participants at low and medium risk of death who reported having had an AD discussion and those who had not (Wilcoxon low risk, P = 0.97; medium risk, P = 0.28; and log-rank low risk, P = 0.82; medium risk, P = 0.45), and for those who had an AD in the medical record vs those who did not (Wilcoxon low risk, P = 0.84; medium risk, P = 0.78; and log-rank low risk, P = 0.86; medium risk, P = 0.69).

CONCLUSIONS:

There is no evidence that AD discussions or documentation result in increased mortality. In regards to the current national debate about the merits of advance care planning, this study suggests that honoring patients' wishes to engage in AD discussions and documentation does not lead to harm. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine

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