Objective -- To determine whether brief general instructions in a proxy-instruction advance directive (California Durable Power of for Health Care [DPAHC]) provide interpretable information about requests to limit life-saving treatments, and to determine whether treatment preferences are stable over time. Design -- Prospective interviews. Setting -- University of California, San Diego Medical and Veterans Affairs Medical Center, La Jolla. Patients -- One hundred patients (from a randomly chosen sample of 185) with a 5-year life of no better than 50% as judged by their physicians. Main Outcome -- Patients completed the California DPAHC, a proxy-instruction directive, at entry and at 1 year. The patients also completed a at entry, after 6 months, and after 1 year, indicating their on a five-point Likert-format comparative rating scale for resuscitation, mechanical ventilation, artificial nutrition, hospitalization for pneumonia. Results -- Sixty-eight percent of the executed the DPAHC. Most patients wished treatments to be limited or under certain conditions of reduced quality of life. Although instructions noted on the DPAHC and preferences regarding specific were stable over the course of a year, the advance directive's instructions were often inconsistent with, and poor predictors of, procedure preferences. Conclusions -- The brief general instruction of the California DPAHC is not helpful in communicating patient regarding specific life-saving procedures.
No takes yet. Share an insight, caveat, or question.
L. J. Schneiderman (1992) studied this question.