Newspaper article Sarasota Herald Tribune

Surprises on Advance Directive Topic

Newspaper article Sarasota Herald Tribune

Surprises on Advance Directive Topic

Article excerpt

The single day I spent at the recent meeting in Orlando of the American Geriatrics Society was enough to suggest that change is happening in the fields of elder and end-of-life medical care.

For one thing, an impressive number of the doctors I saw and spoke with were women -- and it was the youngest crowd of physicians I've ever seen at a professional conference.

But beneath the shifting surface of fresh faces and ideas, traditional medical practices could have a tighter hold on health policies than we realize. Perhaps the most intriguing bit of research at the meeting, in a paper by VJ Periyakoil of the Stanford School of Medicine, was a study of attitude change toward advance directives -- those documents we use to state our preferences about intensive medical treatments to prolong our lives.

She surveyed more than a thousand young doctors, aged 20 to 45, in various specialties at two academic hospitals, asking them about end-of-life care.

Then she compared their answers to ones in a similar survey published in the Journal of the American Medical Association in 1989 -- one year before passage of the federal Patient Self- Determination Act, which established that individuals have a right to refuse treatment even when their doctors believe it would benefit them.

The 1989 survey polled 757 primary care doctors, 92.5 percent of them male -- as opposed to 48.6 percent in the 2013 sample. Given the difference in time and professional demographics, Periyakoil expected to find more contrast in their values than she did.

While "women were a little more positively oriented toward advance directives" than the male doctors in her study, she said, this did not translate into more widespread reliance on patients' written instructions in practice.

Out of 14 statements regarding doctors' attitudes toward advance directives, only three showed slightly more agreement in 2013 than in 1989. …

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