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

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

Medically Reviewed by Laura J. Martin, MD on September 28, 2011
From the WebMD Archives

Sept. 28, 2011 -- Talking about end-of-life care and having advance directives doesn't make death come any more quickly, according to a new study.

Advance directives are legal documents that allow you to record your wishes concerning medical care in the event that you become incapacitated and are unable to speak for yourself.

The study shows that talking with a doctor about end-of-life decisions or having an advance directive did not affect survival rates in a group of 356 people admitted to three different hospitals.

Those who had these discussions with their health care provider or had advance directives in their record were no more likely to die in the following year than those who did not.

The study is published in the Journal of Hospital Medicine.

Researchers say the findings are "reassuring" and contradict the notion that advance directives translate to less aggressive care or cause harm.

"With advance directives, one is allowed to choose the most aggressive measures if that's what matches their goals and values," says researcher Stacy Fischer, MD, assistant professor at the University of Colorado School of Medicine in Aurora. "It's not anyone else deciding, it's you deciding."

Debate Over End-of-Life Care

The researchers say the term "death panels" has sparked controversy in recent years and undermined the efforts of health care providers who provide end-of-life care. They say the term scares people into thinking that their lives might be cut short for their families' or society's best interest.

The term "death panels" was coined in 2009 to describe the provision in the Obama administration's Affordable Care Act that would require Medicare to pay for advance care planning and end-of-life counseling.

David Goodman, MD, professor of pediatrics and health policy at Dartmouth College, says the term "death panels" has become politicized as an unethical form of rationing care.

"It is simply a matter of matching the patient's goals and values to the care that they receive when they are no longer able to express their own wishes," Goodman tells WebMD.

Discussing Advance Directives

In the study, researchers looked at the effect of having a discussion about advance directives or having an advance directive in the medical record on the risk of dying within a year of being admitted to one of three Colorado hospitals.

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.

Show Sources


Fischer, S. Journal of Hospital Medicine, Sept. 28, 2011 online edition.

Stacy Fischer, MD, assistant professor, University of Colorado School of Medicine.

David Goodman, MD, professor of pediatrics and health policy, Dartmouth University.

Joan Teno, MD, professor of health services, policy and practice, Brown University.

News release, Wiley-Blackwell.

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