What is it about?
This article summarises results from 24 research projects including over 23,000 subjects in 10 countries. The objective was to find out whether having patients preferences written in an advance care plan or medical directive improved the way treatment was administered near the end of life. The conclusion was that clinicians were very positive and supportive of the usefulness of having that documentation available to make decisions. However, the studies were mostly based on doctors and nurses perceptions, rather than on measures of effectiveness. We recommend that future studies quantify how beneficial this documentation is in improving end-of-life management in line with patients wishes.
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Why is it important?
While doctor and nurses in-principle support is a good step in the right direction, we still need to measure how much difference the advance health directive makes to patients. Having hard data can guide changes in hospital practice and health policy for public good.
Perspectives
This issue is important because when death from old age and advanced chronic illness is inevitable, medicine can offer less aggressive treatments and these should be in line with patients values and expressed preferences. Not having the documentation leads to clinicians taking the default position of making the decision on behalf of patients.
Magnolia Cardona-Morrell
University of New South Wales
Read the Original
This page is a summary of: Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions: A systematic review, Palliative Medicine, July 2016, SAGE Publications,
DOI: 10.1177/0269216316637239.
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