Apr. 1--A national study today confirms what is already known in the La Crosse area: advance directives work.
That's the conclusion of one of the largest studies on the effectiveness of documents specifying what medical treatments patients want at the end of life. Further, Americans are increasingly making use of the tool.
The study, published in the New England Journal of Medicine, is among the first to look at how well advance directives work.
In a study of 3,746 deaths, researchers found that 42.5 percent of patients had faced treatment decisions near the end of their lives but that more than 70 percent of those people had lacked the ability to make choices because of their mental or physical health. Among that group, however, the majority -- 67.6 percent -- had advance directives.
Moreover, the instructions left in the advance directives were almost always carried out by surrogate decision-makers. The only area cited in the study in which advance directives were not as effective was when patients requested aggressive care.
A program called Respecting Choices, now used by La Crosse's hospitals, nursing homes and other health care providers, received national attention as a model for end-of-life planning amid talk of "death panels" during the health care reform debate. PBS, ABC and other national media aired stories about La Crosse's 15-year-old program.
Bud Hammes, medical ethicist at Gundersen Lutheran, and Nickijo Hagar, Franciscan Skemp vice president of mission and organizational development, spearheaded the La Crosse Medical Centers Task Force on Advance Directives, which developed the communitywide program.
The original goal was to have an advance directive for 50 percent of patients before they had a medical crisis, Hammes said. Today, most patients -- 85 percent -- have a care plan when they die, he said.
Hammes said he saw how distressing it was for three families who had to decide whether to continue dialysis for patients who had suffered serious strokes.
He asked them what their relative would want. "In all three cases, the family said: 'We have no idea. We never talked about it,'" he recalled.
Critics labeled the counseling "death panels" and the proposal was eventually dropped before the researchers could get their report out.
"This is a big change from the early '90s, when studies reported that only about 20 percent of people had advance directives," said Dr. Maria J. Silveira, a clinical scientist at the Veterans Affairs Ann Arbor Healthcare System and an assistant professor at the University of Michigan. "I think it shows the public has bought into this and thinks it's important."
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