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Advanced Directive Discussions Do Not Appear to Affect Survival

Presence of an advanced directive discussion in medical records also not tied to increased mortality

FRIDAY, Sept. 30 (HealthDay News) -- Having advanced directive (AD) discussions or the presence of an AD in the medical records does not appear to result in increased mortality of patients at low or medium risk of death within one year, according to a study published online Sept. 29 in the Journal of Hospital Medicine.

Stacy M. Fischer, M.D., from the University of Colorado School of Medicine in Aurora, and colleagues investigated the impact of AD discussions or an AD in the medical records on patient survival. A total of 356 adults admitted to a general internal medicine service with low or medium risk of death within one year were interviewed to establish whether they had an AD discussion; concurrently, their medical records were reviewed to identify whether an AD was present or not. Participants with high and unclassified risk of death within one year were excluded from the analysis. Survival plots were assessed for those in the low- and medium-risk groups.

The investigators found that survival was not significantly different between participants at low and medium risk of death who had an AD discussion and those who did not. There was no significant difference in survival between patients who had an AD in their medical records versus those who did not.

"There is no evidence that AD discussions or documentation result in increased mortality. In regards to the current national debate about the merits of advance care planning, this study suggests that honoring patients' wishes to engage in AD discussions and documentation does not lead to harm," the authors write.

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