title: Elderly outpatients respond favorably to a physician-initiated advance directive discussion.
abstract: BACKGROUND
  Little is known about the emotional impact of physician-initiated advance directive discussions.
  
  
  METHODS
  One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices of a discussion of health promotion issues. Prediscussion, immediate postdiscussion, and 1-week postdiscussion measures of positive and negative affect were measured for both groups.
  
  
  RESULTS
  Neither discussion topic resulted in adverse emotional or attitudinal responses. Only the advance directive participants showed positive affective and attitudinal responses to the discussion, including an increase in positive affect, an increased sense of physician-patient understanding, and increased thought and discussion about life-support issues in the week following the discussion. For those participants receiving the advance directive discussion, longer physician-patient relationships and higher educational levels significantly predicted a more positive affective response. Lower scores on indices of mental and physical health and a stronger belief that physicians should discuss advance directive issues significantly predicted a more negative affective response to the advance directive discussion.
  
  
  CONCLUSIONS
  Physicians should anticipate positive emotional responses when they initiate advance directive discussions with their elderly outpatients. Advance directive discussions will be received most positively by patients who enjoy good psychological and physical health and when initiated in the context of an established physician-patient relationship.
authors.affiliation: Department of Family Practice, Summa Health System, Akron, OH.
authors.forename: W D
authors.initials: WD
authors.lastname: Smucker
authors.forename: P H
authors.initials: PH
authors.lastname: Ditto
authors.forename: K A
authors.initials: KA
authors.lastname: Moore
authors.forename: J A
authors.initials: JA
authors.lastname: Druley
authors.forename: J H
authors.initials: JH
authors.lastname: Danks
authors.forename: A
authors.initials: A
authors.lastname: Townsend
mesh_terms: D016223:Advance Directives; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003376:Counseling; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D007389:Internal-External Control; D008020:Life Support Care; D008297:Male; D008603:Mental Health; D010045:Outpatients; D010817:Physician-Patient Relations; D011581:Psychological Tests; D011897:Random Allocation