K Michael Lipkin1. 1. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. m-lipkin@northwestern.edu
Abstract
BACKGROUND: Physician-initiated advance care planning is desirable, effective, and routinely indicated for competent adult patients, but doctors are often reluctant to begin the necessary conversations. OBJECTIVE: To determine whether patients are willing and able to designate a surrogate for medical decision making, when asked to do so as part of routine medical inquiry. DESIGN, PATIENTS, MEASUREMENTS: A survey asking patients to name a health care agent was designed and administered in the context of routine clinical care. Participants were drawn from a consecutive sample of 309 competent adult outpatients. Data were analyzed using ordinary descriptive statistics. RESULTS: Two hundred ninety-eight of 309 patients (response rate, 96%) completed the survey and were willing and able to specify a proxy for health care. One third of married participants did not choose their spouse as proxy. CONCLUSIONS: Asking patients to identify a surrogate for medical decision making opens the door for ongoing individualized medical care planning in the context of ordinary patient-physician interaction. This approach is applicable to all competent adults. Documenting proxy choice protects a patient's wishes and preferences until more definitive planning is accomplished.
BACKGROUND: Physician-initiated advance care planning is desirable, effective, and routinely indicated for competent adult patients, but doctors are often reluctant to begin the necessary conversations. OBJECTIVE: To determine whether patients are willing and able to designate a surrogate for medical decision making, when asked to do so as part of routine medical inquiry. DESIGN, PATIENTS, MEASUREMENTS: A survey asking patients to name a health care agent was designed and administered in the context of routine clinical care. Participants were drawn from a consecutive sample of 309 competent adult outpatients. Data were analyzed using ordinary descriptive statistics. RESULTS: Two hundred ninety-eight of 309 patients (response rate, 96%) completed the survey and were willing and able to specify a proxy for health care. One third of married participants did not choose their spouse as proxy. CONCLUSIONS: Asking patients to identify a surrogate for medical decision making opens the door for ongoing individualized medical care planning in the context of ordinary patient-physician interaction. This approach is applicable to all competent adults. Documenting proxy choice protects a patient's wishes and preferences until more definitive planning is accomplished.
Authors: Adam D Schickedanz; Dean Schillinger; C Seth Landefeld; Sara J Knight; Brie A Williams; Rebecca L Sudore Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562