Are emergency department patients thinking about advance directives?

Abstract

Objectives: To assess the percentage of adult patients presenting to an urban ED who have a written advance directive (AD) and to determine whether age, sex, a patient's perception of his or her health status, and having a regular physician are associated with the patient's having an AD. Methods: This was a cross-sectional patient survey performed at a community teaching hospital ED. Surveys were completed by 511 adult ED patients during representative shifts over a 3-month period. The questions included age, sex, 'self-reported', health status, whether the patient had a 'regular' physician, a patient-generated list of medical problems, and whether the patient had a written AD. For this study, ADs included health care proxies, living wills, and do-not-attempt-resuscitation (DNAR) orders. Results: Of the patients surveyed, 27% reported having an AD. Males and females were equally likely to have an AD. Factors associated with an increased likelihood of having an AD were older age, having a 'regular' physician, and the patient's perception of his or her health status as ill. Most patients, who had an AD (82%) discussed it with their families, but only 48% discussed it with their physicians. Conclusion: only 27% of the adult patients presenting to the ED had an AD. Older age, the patient's perception of his or her health status as ill, and having a 'regular' physician increased the likelihood of having an AD.