Elderly outpatients' understanding of a physician-initiated advance directive discussion.
OBJECTIVE
To examine elderly outpatients' understanding of advance directives (ADs), cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration (ANH) with and without the benefit of a physician-initiated discussion.


METHODS
Randomized controlled trial.


METHODS
University-affiliated, community-based, urban family practice residency training program.


METHODS
One hundred patients aged 65 and older, consecutively sampled and randomly assigned to one of two discussion groups.


METHODS
Physicians' discussions based on a prepared script consisting of AD issues or health promotion issues.


METHODS
Test of comprehension of AD, CPR, and ANH information, using open-ended and yes-or-no questions.


RESULTS
Patients in the AD and health promotion discussion groups showed good basic understanding. Younger and better-educated patients had a better working knowledge of AD-related information. Understanding of ADs was higher when the physician spent more time talking about AD-related issues after the discussion was completed.


CONCLUSIONS
Many elderly outpatients have a good basic understanding of ADs, CPR, and ANH, even without explicit explanations from physicians. However, younger, better-educated patients and those who had longer unstructured discussions had greater AD-related knowledge. These factors need to be considered when framing discussions with patients about ADs and life-sustaining treatments.
Moore
K A
KA
Department of Psychology, Kent State University, Ohio.
Danks
J H
JH
Ditto
P H
PH
Druley
J A
JA
Townsend
A
A
Smucker
W D
WD
D016223:Advance Directives; D000368:Aged; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation; D003071:Cognition; D003142:Communication; D032882:Comprehension; D035061:Control Groups; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D010045:Outpatients / Q000523:psychology*; D010288:Parenteral Nutrition; D010353:Patient Education as Topic / Q000379:methods; D010817:Physician-Patient Relations; D012044:Regression Analysis; D011795:Surveys and Questionnaires