title: Life-sustaining treatments: what do physicians want and do they express their wishes to others?
abstract: OBJECTIVE
  To assess whether older physicians have discussed their preferences for medical care at the end of life with their physicians, whether they have established an advance directive, and what life-sustaining treatment they wish in the event of incapacity to make these decisions for themselves.
  
  
  METHODS
  Mailed survey to a cohort of physicians.
  
  
  METHODS
  Physicians who were medical students at the Johns Hopkins University in graduating classes from 1946 to 1964.
  
  
  METHODS
  Physicians who completed the advance directive questionnaire (mean age 68).
  
  
  METHODS
  Questionnaires were sent out to known surviving physicians of the Precursors Study, an on-going study that began in 1946, asking physicians about their preferences for life-sustaining treatments.
  
  
  RESULTS
  Of 999 physicians who were sent the survey, 765 (77%) responded. Forty-six percent of the physicians felt that their own doctors were unaware of their treatment preferences or were not sure, and of these respondents, 59% had no intention of discussing their wishes with their doctors within the next year. In contrast, 89% thought their families were probably or definitely aware of their preferences. Sixty-four percent reported that they had established an advance directive. Compared with physicians without advance directives, physicians who established an advance directive were more likely to believe that their doctors (odds ratio (OR) = 3.42, 95% confidence interval (CI) = 2.49-4.69) or family members (OR = 9.58, 95% CI = 5.33-17.23) were aware of their preferences for end-of-life care and were more likely to refuse treatments than those without advance directives.
  
  
  CONCLUSIONS
  This survey of physicians calls attention to the gap between preferences for medical care at the end of life and expressing wishes to others through discussion and advance directives, even among physicians.
authors.affiliation: Department of Family Practice and Community Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. jjgallo@mail.med.upenn.edu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Straton
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Klag
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Meoni
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Sulmasy
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
mesh_terms: D016223:Advance Directives; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003142:Communication; D005195:Family Relations; D005260:Female; D006306:Health Surveys; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians; D013727:Terminal Care