Can goals of care be used to predict intervention preferences in an advance directive?

BACKGROUND: Some have suggested that advance directives elicit goals care from patients, instead of or in addition to specific intervention, but little is known about whether goals of care can be used in a way on documents or whether they can predict preferences for interventions. METHODS: Attending physicians (n = 716) at the General Hospital in Boston were surveyed to elicit general goals care (eg, treat everything or comfort measures only) along with specific for 11 medical interventions in 6 scenarios. In each scenario, goal was classified as an adequate predictor of acceptance or rejection an intervention if its predictive value of the preference for that was at least 80%. RESULTS: Goals varied with scenarios (P less .001) in a predictable manner. The goal treat everything was an adequate of acceptance of each intervention, and comfort was an adequate of rejection for nearly every intervention. Attempt cure adequately acceptance of almost every nonaggressive intervention, but did not acceptance of aggressive interventions. Quality of life predicted of aggressive interventions in 3 scenarios, but was not useful in cases. When goals were predictors of preferences, the mean range of 95% intervals for their predictive values was generally 20% or less. : Goals have a valid role in advance directives, since the goal had a logical relationship to scenarios and intervention choices. , the 2 goals attempt cure and choose quality of life were not in many instances. If these findings hold true for more general of patients, then advance directive documents will need to rely on than these general goal statements if they are to adequately represent preferences.