WEDNESDAY, Sept. 28 (HealthDay News) -- New research suggests
that sick people who talk about advance directives don't die
earlier than their counterparts who don't have those discussions
about end-of-life care.
The study only looked at patients who were mildly or moderately
ill, not those who were expected to die soon. And the study doesn't
definitively prove that the discussions don't affect death
Still, the findings suggest that "having a discussion or
completing a directive doesn't lead to harm. We can promote
autonomy, and not be worried that we're harming patients," said
study author Dr. Stacy M. Fischer, an assistant professor at the
University of Colorado School of Medicine.
Fischer and her colleagues launched their study in the wake of
the 2009 health care debate, after a provision that allowed funding
for advance directive discussions under the Medicare program came
under scrutiny, according to background information in the study.
Although this provision had been in place during the George W. Bush
administration, the Obama administration removed the provision from
the Affordable Care Act so that the issue could not cloud the
larger debate about affordable health care, the study said. The
controversy also introduced the term "death panels" to the public.
Media reports say no such panels -- alleged to allow doctors to
make decisions about who lives or dies -- actually existed in
President Obama's health care reform proposal.
Ordinary advance directive discussions can be difficult. Dr.
Jennifer Mack, an assistant professor at Harvard Medical School
who's familiar with the findings, said patients and families
sometimes don't feel positive about advance directive discussions.
"They feel that the physicians who bring these issues up are not
necessarily acting in their best interest, but have a particular
agenda," she said.
Mack added that some people may be concerned about a
"self-fulfilling prophecy" -- the idea that "if we say a patient
has two weeks to live, the patient will believe that."
Fischer said she wanted to address a concern that the discussion
of "death panels" implies that advance directives will "somehow
lead families or health care providers into stopping providing
The study authors examined the medical records of 458 patients
at Colorado hospitals who were asked at their bedside whether
they'd taken part in discussions about advance directives. The
researchers focused on 356 people who were thought to be at low
(297 people) or medium (59 people) risk of dying over the next
year; the study left out those who were expected to die imminently
because that fact would be "driving those discussions," Fischer
The researchers found that 45 percent of the 356 patients said
they'd had discussions about advance directives, although just 10
percent had advance directive documents included with their medical
charts. Six percent had living wills, 9 percent had documents that
gave someone else a durable power of attorney, and 7 percent had
other types of similar documents.
About one-quarter of the patients died during the 2003-2009
follow-up period of the study. The researchers found that having a
discussion about advance directives didn't boost or lower a
patient's risk of death.
The researchers wrote that their study offers "limited data to
counteract the misleading claims of those opposed to the advance
care planning process."
Mack said the study appears to be sound, although the number of
subjects is relatively small. "Trying to provide data to address
some of these assumptions is probably a good thing," she said.
The study was published online Sept. 28 in the
Journal of Hospital Medicine.
For more about
advance directives, try the U.S. National Library of Medicine.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.