Compliance with and understanding of advance directives among trainee doctors in the United Kingdom

J Palliat Care. Autumn 2006;22(3):141-6.


Aim: To investigate doctors' response to and understanding of the legal status of advance directives.

Methods: A vignette-based study administered at palliative medicine, oncology, general practice, and geriatric medicine specialist registrar meetings (United Kingdom). Respondents determined the treatment to provide for a patient presenting with a myocardial infarction with or without an advance directive requesting maximum therapy.

Results: Response rate 77% (43/56). Twenty-five percent (10/40) of respondents increased the care that they would provide in response to the advance directive (p = 0.004); 77% (33/43) support/strongly support use of advance directives; 51% (22/43) did not know the legal status of advance directives; 44% found that their medical school education was not an important influence on their decision making.

Conclusions: Advance directives requesting treatment can increase the level of care provided by the physician, however, most trainees chose a level of care different from that in the advance directive. Confusion exists among doctors about the legal status of advance directives, which limits their usefulness. Medical education needs to be improved to train doctors to deal with advance directives.

MeSH terms

  • Advance Directive Adherence / legislation & jurisprudence
  • Advance Directive Adherence / standards*
  • Advance Directives* / legislation & jurisprudence
  • Alzheimer Disease / complications
  • Attitude of Health Personnel*
  • Clinical Competence / standards
  • Comprehension
  • Critical Care / organization & administration
  • Curriculum / standards
  • Decision Making
  • Education, Medical, Graduate
  • England
  • Family Practice / education
  • Geriatrics / education
  • Health Knowledge, Attitudes, Practice*
  • Health Services Needs and Demand
  • Humans
  • Medical Oncology / education
  • Medical Staff* / education
  • Medical Staff* / psychology
  • Mental Competency
  • Myocardial Infarction / etiology
  • Myocardial Infarction / therapy
  • Palliative Care / organization & administration
  • Patient Selection
  • Statistics, Nonparametric
  • Surveys and Questionnaires