Advance directives provide comfort, not necessarily goal

Research says instructional directives may have psychological benefits, but a new study also found they don't improve the accuracy of surrogate decision-making.

By Vida Foubister, AMNews staff. March 19, 2001.

When William M. Tierney, MD, was diagnosed with non-Hodgkin's lymphoma last year, he filled out an advance directive for the first time.

Dr. Tierney, professor of medicine at Indiana University School of Medicine in Indianapolis, said he was glad that his oncologist suggested it. "I feel comforted that I'm not going to be a burden to my family," he explained.

Just as Dr. Tierney found talking about end-of-life preferences with his physician to be beneficial, so did the elderly and chronically ill patients who participated in a study he led.

Patients who discussed advance directives with their physicians were more likely to rank those visits as excellent than patients who didn't receive such counseling as part of their primary care, according to his findings, published in the January Journal of General Internal Medicine.

"If you talk to your patients about these things, you fundamentally change the relationship that you have with your patients," Dr. Tierney said.

But does he expect those discussions to make a difference in the care either he or those patients ultimately receive? The answer is no. "There are very few direct benefits," he admitted.

As it turns out, Dr. Tierney's expectations appear to be on the mark.

A recent study that for the first time looked retrospectively at the effect of such interventions found that neither the advance directives themselves nor discussions among patients and their surrogate decision-makers about them improve the accuracy of substituted judgment. [...]