Physician perspectives and compliance with patient advance directives: The role external factors play on physician decision making

Christopher M. Burkle, Paul Mueller, Keith M. Swetz, C. Christopher Hook, Mark T. Keegan

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians' decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients' ability to comprehend complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods. Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents' perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results: Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient's AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to "pass away in peace." Few (17%) would forgo an AD following a family's request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician's decision as to whether to comply with a patient's AD. Conclusions: Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient's initial wishes and preferences expressed by the AD.

Original languageEnglish (US)
Article number31
JournalBMC Medical Ethics
Volume13
Issue number1
DOIs
StatePublished - 2012

Fingerprint

Advance Directives
Patient Compliance
Decision Making
physician
Physicians
decision making
Patient Preference
Advance Directive Adherence
Health Care Costs
costs
Patient Self-Determination Act
health care
Living Wills
Delivery of Health Care
Continuing Medical Education
Aptitude
Terminal Care
self-determination
Medicaid
Patient Rights

Keywords

  • Advance directive
  • Patient preference
  • Physician decision making

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Health Policy

Cite this

Physician perspectives and compliance with patient advance directives : The role external factors play on physician decision making. / Burkle, Christopher M.; Mueller, Paul; Swetz, Keith M.; Hook, C. Christopher; Keegan, Mark T.

In: BMC Medical Ethics, Vol. 13, No. 1, 31, 2012.

Research output: Contribution to journalArticle

Burkle, Christopher M. ; Mueller, Paul ; Swetz, Keith M. ; Hook, C. Christopher ; Keegan, Mark T. / Physician perspectives and compliance with patient advance directives : The role external factors play on physician decision making. In: BMC Medical Ethics. 2012 ; Vol. 13, No. 1.
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