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Advance care planning focus of awareness campaign

Only a third of patients have living wills, and fewer than half of patients who have severe or terminal illnesses have advance directives, according to the Agency for Healthcare Research and Quality. More than 850 hospitals, hospices, law firms and other organizations around the country are hoping to change that April 16 by participating in the third annual National Healthcare Decisions Day. The event is designed to raise awareness about the need for advance care planning and make it easier for patients to make their wishes known. More than a quarter of dying patients lack the capacity to make end-of-life care decisions, says a study in the April 1 New England Journal of Medicine (content.nejm.org/cgi/content/short/362/13/1211/). For the two-thirds of patients who planned in advance -- completing a living will or appointing a durable power of attorney -- most received care consistent with their wishes, according to the study, which looked at 3,746 patients from 2000 to 2006. Nearly all the patients who requested only comfort care received it, for example. But physicians often are faced with caring for patients who have no planning documents or whose paperwork does not apply to the clinical situation at hand, says a survey of 281 Chicago-area physicians reported in the March Journal of the American Geriatrics Society (www3.interscience.wiley.com/journal/123280174/abstract). Even when these doctors had living wills to refer to or had had prior conversations with patients about end-of-life care, they relied on patient preferences less than half the time. Physicians most frequently cited "what was best for the patient overall" -- not "what the patient would have wanted you to do" -- as the most important factor in caring for hospitalized patients who had lost decision-making capacity. "When physicians can talk with the patient, they should put tremendous weight on what the patient says," said Alexia Torke, MD, lead author of the study. "But when patients lose that capacity, things become much more complicated. Physicians have to consider multiple factors, rather than just what the patient wanted." Those other factors include adjusting care for the patient's current prognosis, respecting the patient as a person, honoring the family's wishes and reducing the patient's pain and suffering, said Dr. Torke, assistant professor of medicine at the Indiana University School of Medicine. The American Medical Association strongly supports advance directives and durable power of attorney for health care. More information about the annual National Healthcare Decisions Day is online (www.nationalhealthcaredecisionsday.org/). The full and original article can be found here: http://www.ama-assn.org/amednews/2010/04/12/prse0416.htm
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