Advance Directives Improve End-of-Life Communication

But researchers find that directives don't guarantee adequate care in last months of life

MONDAY, Feb. 19 (HealthDay News) -- The use of advance directives by a terminally ill patient is associated with better doctor-patient communication in the last months of life, but opportunities remain to improve the quality of end-of-life care, researchers report in the February issue of the Journal of the American Geriatrics Society.

Joan M. Teno, M.D., of the Brown Medical School in Providence, R.I., and colleagues interviewed bereaved family members about the use of advance directives and end-of-life care in 1,587 decedents, 70.8 percent of whom had an advance directive.

The decedents with an advance directive were less likely than those without one to have a feeding tube (17 percent versus 27 percent) or use a respirator in the last month of life (11.8 percent versus 22 percent). Although family members of decedents who did not have an advance directive were more likely to report concerns with physician communication and with being informed about what to expect, one in four relatives of decedents with an advance directive reported an unmet need in pain, and one in two reported inadequate emotional support for the patient.

"With the demographic projections of the 'baby boomers,' the ability to provide competent, coordinated and compassionate care to older adults throughout the course of illness and the dying process is becoming increasingly urgent," the authors conclude.

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