Outpatients' attitudes regarding advance directives.

BACKGROUND: Although many bedside ethical dilemmas can be avoided if patients discuss their wishes regarding the use of life-prolonging treatment and aggressiveness of care, many physicians are reluctant to raise this issue with their patients. Physicians may wait for such discussions until a patient is ill or elderly or until the patient raises the issue first.
METHODS: Three hundred adult patients visiting their family physician's office were asked to complete a 19-item questionnaire. In addition to providing demographic information, they were asked whether they had discussed their wishes regarding life-prolonging treatments with their physician; what their attitude was toward having these discussions in various situations; whom they wanted to initiate the discussion, and with whom else they had discussed their wishes.
RESULTS: Of the respondents who had not previously discussed their wishes with their physician, 68% wanted the physician to initiate the discussion. Only 11% did not want their physician to bring up the subject. A majority of respondents in all age groups thought it was somewhat or very important to discuss this matter both when healthy and when very ill.
CONCLUSIONS: Very few patients would be upset if their physician raised the issue of life-prolonging treatment even if he or she did so during an initial patient visit. To avoid problems later, physicians should take an active role by raising these questions early in the patient-physician relationship rather than waiting for the patient to do so.