title: "They're going to unplug grandma": advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death.
abstract: OBJECTIVE
  To determine the effect of having advance directive (AD) discussions or having an AD in the medical record on patient survival.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Three Colorado area hospitals: a large academic tertiary referral center, a Veteran's Affairs medical center, and an urban safety net hospital.
  
  
  METHODS
  Four hundred fifty-eight adults admitted to the general internal medicine service interviewed about AD discussions. A concurrent chart review documented the presence of an AD in the medical record. Participants were stratified into low, medium, and high risk of death within 1 year based on validated prognostic criteria.
  
  
  METHODS
  Kaplan-Meier survival plots were estimated for those at low and medium risk of death.
  
  
  RESULTS
  No significant differences in survival for participants at low and medium risk of death who reported having had an AD discussion and those who had not (Wilcoxon low risk, P = 0.97; medium risk, P = 0.28; and log-rank low risk, P = 0.82; medium risk, P = 0.45), and for those who had an AD in the medical record vs those who did not (Wilcoxon low risk, P = 0.84; medium risk, P = 0.78; and log-rank low risk, P = 0.86; medium risk, P = 0.69).
  
  
  CONCLUSIONS
  There is no evidence that AD discussions or documentation result in increased mortality. In regards to the current national debate about the merits of advance care planning, this study suggests that honoring patients' wishes to engage in AD discussions and documentation does not lead to harm.
authors.affiliation: Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. Stacy.Fischer@ucdenver.edu.
authors.forename: Stacy M
authors.initials: SM
authors.lastname: Fischer
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000639:trends*; D000368:Aged; D015331:Cohort Studies; D004282:Documentation / Q000379:methods / Q000639:trends*; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012307:Risk Factors