"They're going to unplug grandma": advance directive discussions and documentation do not decrease survival in patients at baseline lower risk of death.

Abstract

OBJECTIVE: To determine the effect of having advance directive (AD) discussions or having an AD in the medical record on patient survival. DESIGN: Prospective observational cohort study. SETTING: Three Colorado area hospitals: a large academic tertiary referral center, a Veteran's Affairs medical center, and an urban safety net hospital. PARTICIPANTS: Four hundred fifty-eight adults admitted to the general internal medicine service interviewed about AD discussions. A concurrent chart review documented the presence of an AD in the medical record. Participants were stratified into low, medium, and high risk of death within 1 year based on validated prognostic criteria. MEASURES: Kaplan-Meier survival plots were estimated for those at low and medium risk of death. RESULTS: No significant differences in survival for participants at low and medium risk of death who reported having had an AD discussion and those who had not (Wilcoxon low risk, P = 0.97; medium risk, P = 0.28; and log-rank low risk, P = 0.82; medium risk, P = 0.45), and for those who had an AD in the medical record vs those who did not (Wilcoxon low risk, P = 0.84; medium risk, P = 0.78; and log-rank low risk, P = 0.86; medium risk, P = 0.69). CONCLUSIONS: 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.