title: The doctor's role in discussing advance preferences for end-of-life care: perceptions of physicians practicing in the VA.
abstract: OBJECTIVE
  Although previous studies have shown physicians support advance directives, little is known about how they actually participate in decision-making. This study investigate (1) how much experience physicians have had discussing and following advance preferences and (2) how physicians perceive their role in the advance decision-making process.
  
  
  METHODS
  Mail survey conducted in 1993.
  
  
  METHODS
  The Department of Veterans Affairs.
  
  
  METHODS
  A national probability sample of 1050 VA internists, family physicians, and generalists.
  
  
  RESULTS
  Questionnaires were returned by 67% of participants. In the last year, 79% stated they had discussed advance preference with at least one patient, and 19% had talked to more than 25. Seventy-three percent had used a written directive to make decisions for at least one incompetent patient. Younger age, board certification, spending less time in the outpatient setting, and personal experience with advance decision-making, were all associated independently with having advance preference discussions. Among physicians who had discussions, 59% said they often initiated the discussion, 55% said discussions often occurred in inpatient settings, and 31% said discussions often occurred in outpatient settings. Eighty-two percent of those responding thought physicians should be responsible for initiating discussions. Most would try to persuade a patient to change a decision that was not well informed (91%), not medically reasonable (88%), or not in the patient's best interest (88%); few would attempt to change decisions that conflicted with their own moral beliefs (14%).
  
  
  CONCLUSIONS
  Physicians report that they are actively involved with their patients in making decisions about end-of-life care. Most say they have had recent discussions with at least some of their patients and feel that as physicians they should play a large and important role in soliciting and shaping patient preferences.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
authors.forename: L
authors.initials: L
authors.lastname: Markson
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.forename: L
authors.initials: L
authors.lastname: Glantz
authors.forename: V
authors.initials: V
authors.lastname: Lamberton
authors.forename: D
authors.initials: D
authors.lastname: Kern
authors.forename: G
authors.initials: G
authors.lastname: Stollerman
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives / Q000523:psychology; D001291:Attitude of Health Personnel; D003657:Decision Making; D035082:Federal Government; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D028681:Moral Obligations; D010353:Patient Education as Topic; D010819:Physician's Role; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States