The Hard Task of Creating End of Life Directives

Promoting Advance Directives Among Elderly Primary Care Patients  is a study from 2004 for the Journal of General Internal Medicine. The study sought to determine efficient ways of promoting end of life directives (directions) in cognizant, alert senior citizens. The study revealed several things which shouldn’t surprise anyone. Here is a partial list:

  • Discussing Your Own Death is not Popular – even when counseled by doctors and mailed material and being over 75, less than 10% of the patients created a new end-of-life directive. Not only are people wary of making plans surrounding their demise, doctors often were cajoled and reminded to start the conversation. Doctors said they didn’t have the time to discuss the issue with patients even when allowed time during the workday to do this. The ethical ramifications seem to weigh on them particularly if they worked for assisted living or nursing homes.
  • Higher Income Seniors were More Willing to Make Provisions for End of Life Care – The patients who had a higher median income (52k for the study) were twice as willing to make a new directive for the end of their lives than those with a median income lower than the state average were. Wealthier households are usually better educated, read more and stay abreast the latest news (health, advances in medicine, technology, etc.). Poorer households may be more suspicious of doctor’s intentions.
  • Patients Still Trust their Doctors, Particularly Long Term Patients – Patients over 75 who already had directives on file updated them 15% of the time when prompted by a physician intervention vs 4% w/o a physician’s discussion.

end of life directives, end of life planning


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