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Palliative Care Center

Talking About End-of-Life Care Doesn't Raise Death Risk

Study Shows People Who Prepare Advance Directives Don't Die Sooner
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Discussing Advance Directives continued...

All of the 356 participants were classified as having a low or medium risk of dying within the following year.

Overall, 45% reported having a discussion about advance directives with a health care provider, but only 19% had an advance care directive document on their chart.

During the study between 2003 and 2009, 26% of the participants died. Researchers found no difference in the risk of death between those who had an advance directive or a discussion about advance directives and those who did not.

Planning While You're Still Healthy

Experts say the time to have discussions about end-of-life care and advance directives with a health care provider is long before a person gets sick.

"The time to do advance care planning is when you are healthy, long before facing serious illness. At the time of serious illness, it may be more frightening," Fischer says.

Fischer says the conversation should include a frank discussion about a person's values and goals and what makes life worth living for them. Then, health care providers can help choose medical care that goes with those values.

Goodman agrees.

"What people want is to not just live long, but to live well," Goodman says. "Very few people want to live longer if they are in great pain, unaware of their surroundings, or if the interventions that are supposed to help them are actually doing harm."

Geriatrician Joan Teno, MD, of Brown University says the study highlights the need for these conversations to happen during an office visit and not in the middle of the night at the time of a crisis.

"Too often these conversations do not occur and the patient ends up getting what their doctor believes they want and is not based on what their goals of care are," says Teno, professor of health services, policy, and practice at Brown. "Advance directives are not only for saying what care you don't want, but they can also be for stating the care that you do want."

Teno says the results of this study are reassuring and a reminder that good health care is based on shared decision making.

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