title: Advance directives in an oncologic intensive care unit: a contemporary analysis of their frequency, type, and impact.
abstract: BACKGROUND
  Our objective was to provide a contemporary analysis of the prevalence, types, and impact of advance health care directives in critically ill cancer patients.
  
  
  METHODS
  We retrospectively reviewed all intensive care unit (ICU) admissions (January 1, 2006 to April 25, 2008) at an oncologic center and identified all patients who completed a living will (LW), or health care proxy (HCP), or neither prior to ICU admission. Demographics, clinical data, end-of-life (EOL) parameters and outcomes were compared among three groups: LWs, HCPs, and no LW or HCP.
  
  
  RESULTS
  Of 1,333 ICU admissions, 1,121 patients (84%) were included for analysis: 176 patients (15.7%) had LW, 534 (47.6%) had HCP and 411 (36.7%) had no LW or HCP. Patients with LW were significantly more likely to be older and white as compared to patients with HCP alone, or no LW or HCP. There were no significant demographic differences between patients with HCP or no LW or HCP. Patients with HCP alone, or no LW or HCP, were significantly more likely to have Medicaid than patients with LW. There were no differences noted in ICU care, EOL management, or outcomes among the three groups.
  
  
  CONCLUSIONS
  The prevalence of LWs in patients admitted to our oncologic ICU is low. More than half of the remaining patients had designated HCPs. Older age and white race were associated with the presence of LWs. However, the presence of LWs or HCPs did not influence ICU care, EOL management or outcomes at our institution.
authors.affiliation: Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, New York, New York, USA. halpernn@mskcc.org
authors.forename: Neil A
authors.initials: NA
authors.lastname: Halpern
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pastores
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Chou
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chawla
authors.forename: Howard T
authors.initials: HT
authors.lastname: Thaler
mesh_terms: D016223:Advance Directives / Q000145:classification* / Q000639:trends*; D000368:Aged; D002173:Cancer Care Facilities; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009519:New York City; D016522:Oncology Service, Hospital; D012189:Retrospective Studies