title: Micromanaging death: process preferences, values, and goals in end-of-life medical decision making.
abstract: OBJECTIVE
  This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made.
  
  
  METHODS
  Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a longitudinal study designed to investigate psychological assumptions underlying the use of advance directives. Three-hundred thirty-seven outpatients aged 65 and older and their designated surrogate decision makers completed interviews and questionnaires.
  
  
  RESULTS
  Very few individuals wished to document specific medical treatment preferences and mandate that they be followed, without exception, near death. Most desired to express more general preferences, such as values and goals for care, in addition to (or, instead of) specific treatment preferences and to allow surrogate decision makers leeway in decision making. Patient-to-patient variability with regard to process preferences was substantial, as was surrogates' misunderstanding of the patients' process preferences.
  
  
  CONCLUSIONS
  Very few individuals may desire the standard approach to advance care planning whereby preferences for specific life-sustaining treatments are documented and these requests are strictly followed near death. Instead, patient autonomy may be better served by emphasizing discussion of process preferences and leeway in decision making.
authors.affiliation: Department of Psychology and Social Behavior, University of California, Irvine, 3340 Social Ecology II, Irvine, CA 92697-7085, USA.
authors.forename: Nikki Ayers
authors.initials: NA
authors.lastname: Hawkins
authors.forename: Peter H
authors.initials: PH
authors.lastname: Ditto
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Danks
authors.forename: William D
authors.initials: WD
authors.lastname: Smucker
mesh_terms: D016223:Advance Directives; D000368:Aged; D003657:Decision Making; D006801:Humans; D007407:Interviews as Topic; D011795:Surveys and Questionnaires; D019452:Terminally Ill