Policy makers encourage physicians to discuss advance directive issues with healthy elderly outpatients as part of comprehensive primary care. Current policy and law regarding advance directives presume that: 1) recording patients' treatment preferences prior to decisional incapacity will improve the accuracy of surrogate decision makers, 2) patients' life- sustaining treatment preferences are stable over time and across changes in health state, and 3) treatment preferences stated in response to hypothetical illness scenarios are authentic in that they are identical to the treatment choices patients would make during actual illness episodes. The lack of empirical data to support these assumptions highlights the need for research measuring the outcomes of advance directives on surrogate decision-making, the stability of patients' treatment preferences over time, and the agreement between hypothetical treatment preferences and those stated during actual illness episodes. Four-hundred elderly outpatients and their designated surrogates for life- sustaining treatment decisions will be recruited from a network of family practice physicians. The chief goals of the proposed study are to: 1) use a randomized control trial to compare the ability of three different methods of collecting advance directive information to improve the agreement between decisions made by elderly outpatients and their surrogates about the use of life-sustaining treatments, 2) follow patients longitudinally for two years to measure the stability of elderly outpatients' decisions about life-sustaining treatments over time and across changes in health state, and 3) interview hospitalized study patients and their surrogates to compare treatment preferences and predictions made prior to hospitalization to those made during actual illness episodes. The knowledge gained from the proposed research will provide empirical data to determine policy and law regarding: 1) the most effective process of eliciting and recording advance directive information, 2) the need for updating recorded advance directive information after specific time intervals or important health changes, and 3) the extent to which life- sustaining treatment preferences recorded by healthy individuals should be taken as authentic representations of those individuals' treatment choices in actual illness episodes.
| Zettel-Watson, Laura; Ditto, Peter H; Danks, Joseph H et al. (2008) Actual and perceived gender differences in the accuracy of surrogate decisions about life-sustaining medical treatment among older spouses. Death Stud 32:273-90 |
| Houts, Renate M; Smucker, William D; Jacobson, Jill A et al. (2002) Predicting elderly outpatients' life-sustaining treatment preferences over time: the majority rules. Med Decis Making 22:39-52 |
| Smucker, W D; Houts, R M; Danks, J H et al. (2000) Modal preferences predict elderly patients' life-sustaining treatment choices as well as patients' chosen surrogates do. Med Decis Making 20:271-80 |
