Advance directives provide means for competent individuals to influence treatment decisions in the event of serious illness and subsequent loss of competence, the "living will" being the best known example. Physicians in Arkansas who were identified to be currently engaged in general practice, family medicine, or internal medicine, including its subspecialities (N = 1293), were surveyed to assess attitudes toward and experiences with advance directives. Almost 80% of all respondents expressed a positive attitude and fewer than 2% expressed a negative attitude toward such documents. A majority (55.9%) had actual experience with the instruments in their practices, and 83.5% of these physicians said that their attitude had become more positive as a result of their experience. More frequent employment of advance directives in critical situations was associated with more positive attitudes and experiences. Most of the benefits claimed for advance directives--improved communication and trust, easier and more confident treatment decision, less stress and guilt, and promotion of patient autonomy--were substantiated by the results.
KIE: Physicians practicing in Arkansas, one of the first states to pass legislation authorizing patients to refuse life-sustaining treatment in advance, were surveyed to determine their attitudes toward advance directives. Questionnaires were sent to 1,293 practitioners in general practice, family practice, and internal medicine and its subspecialties. Among other items, respondents were asked their opinions of the standard arguments for and against advance directives, and the extent of and results of their own experiences with these documents. Almost 80% of the 790 respondents reported a positive attitude toward advance directives, with 1.5% reporting a negative attitude. A majority of physicians responding to the survey had actual experience with advance directives, and over 80% of these doctors reported that their attitude had become more favorable as a result of their experience. Respondents strongly supported arguments for advance directives that concerned patient autonomy.