The oncology nurse's role in patient advance directives.

In December 1991, Patient Self-Determination Amendment (PSDA) legislation was implemented. The PSDA requires facilities funded by Medicare/Medicaid to inform patients of their decision-making rights regarding medical care. An advance directive (AD), a living will, or a durable power of attorney for health care contains statements made by competent people directing their medical care if they should become incompetent. Oncology nurses are in an advantageous position to educate and advocate for their patients with respect to end-of-life decisions. They are qualified to facilitate the AD process by virtue of their ability to relate to patients and families their extensive experience with the terminally ill and their expertise as liasons between patients, families, and the multidisciplinary team. A clear understanding of the patient's wishes regarding life-sustaining treatments enables the oncology nurse to advocate more effectively on the patient's behalf. This article highlights definitions of ADs, advantages and disadvantages of each, and recommendations for the oncology nurse's practice.