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“They're going to unplug grandma”: Advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death
Author(s) -
Fischer Stacy M.,
Min SungJoon,
Sauaia Angela,
Kutner Jean S.
Publication year - 2012
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.930
Subject(s) - medicine , documentation , hospital medicine , referral , proportional hazards model , medical record , hazard ratio , family medicine , emergency medicine , confidence interval , computer science , programming language
OBJECTIVE: To determine the effect of having advance directive (AD) discussions or having an AD in the medical record on patient survival. DESIGN: Prospective observational cohort study. SETTING: Three Colorado area hospitals: a large academic tertiary referral center, a Veteran's Affairs medical center, and an urban safety net hospital. PARTICIPANTS: 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. MEASURES: 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. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine