An update on advance directives in the medical record

Findings from 1186 consecutive patients with unresectable exocrine pancreas cancer

Tow S. Tan, Aminah Jatoi

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. Methods/Results: The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15%) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95% confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24%) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the "contact person." Conclusion: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.

Original languageEnglish (US)
Pages (from-to)100-103
Number of pages4
JournalJournal of Gastrointestinal Cancer
Volume39
Issue number1-4
DOIs
StatePublished - Mar 2008

Fingerprint

Advance Directives
Exocrine Pancreas
Pancreatic Neoplasms
Medical Records
Neoplasms
Multivariate Analysis
Odds Ratio
Confidence Intervals
Delivery of Health Care

Keywords

  • Advance directive
  • Pancreas cancer
  • Tertiary medical center

ASJC Scopus subject areas

  • Gastroenterology
  • Oncology

Cite this

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title = "An update on advance directives in the medical record: Findings from 1186 consecutive patients with unresectable exocrine pancreas cancer",
abstract = "Background: The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. Methods/Results: The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15{\%}) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95{\%} confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24{\%}) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the {"}contact person.{"} Conclusion: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.",
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N2 - Background: The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. Methods/Results: The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15%) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95% confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24%) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the "contact person." Conclusion: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.

AB - Background: The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. Methods/Results: The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15%) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95% confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24%) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the "contact person." Conclusion: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.

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