title: Accuracy of a decision aid for advance care planning: simulated end-of-life decision making.
abstract: OBJECTIVE
  Advance directives have been criticized for failing to help physicians make decisions consistent with patients' wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients' wishes into treatment decisions.
  
  
  METHODS
  We recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios. From the three individual physicians' responses, a "consensus physician response" was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.
  
  
  RESULTS
  Patient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR). Across the six vignettes, patient-participants' rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians' overall rating of their confidence at accurately translating patients' wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).
  
  
  CONCLUSIONS
  For simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse.
authors.affiliation: Department of Humanities, Penn State College of Medicine, Hershey, USA. bhlevi@psu.edu
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Levi
authors.forename: Steven R
authors.initials: SR
authors.lastname: Heverley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
mesh_terms: D032722:Advance Care Planning / Q000941:ethics* / Q000592:standards; D016223:Advance Directives; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations / Q000941:ethics; D010820:Physicians / Q000941:ethics / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012107:Research Design; D018401:Sample Size