The doctor's role in discussing advance preferences for end-of-life care: perceptions of physicians practicing in the VA

J Am Geriatr Soc. 1997 Apr;45(4):399-406. doi: 10.1111/j.1532-5415.1997.tb05162.x.


Objectives: Although previous studies have shown physicians support advance directives, little is known about how they actually participate in decision-making. This study investigate (1) how much experience physicians have had discussing and following advance preferences and (2) how physicians perceive their role in the advance decision-making process.

Design: Mail survey conducted in 1993.

Setting: The Department of Veterans Affairs.

Participants: A national probability sample of 1050 VA internists, family physicians, and generalists.

Measurements and main results: Questionnaires were returned by 67% of participants. In the last year, 79% stated they had discussed advance preference with at least one patient, and 19% had talked to more than 25. Seventy-three percent had used a written directive to make decisions for at least one incompetent patient. Younger age, board certification, spending less time in the outpatient setting, and personal experience with advance decision-making, were all associated independently with having advance preference discussions. Among physicians who had discussions, 59% said they often initiated the discussion, 55% said discussions often occurred in inpatient settings, and 31% said discussions often occurred in outpatient settings. Eighty-two percent of those responding thought physicians should be responsible for initiating discussions. Most would try to persuade a patient to change a decision that was not well informed (91%), not medically reasonable (88%), or not in the patient's best interest (88%); few would attempt to change decisions that conflicted with their own moral beliefs (14%).

Conclusions: Physicians report that they are actively involved with their patients in making decisions about end-of-life care. Most say they have had recent discussions with at least some of their patients and feel that as physicians they should play a large and important role in soliciting and shaping patient preferences.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Advance Care Planning*
  • Advance Directives* / psychology
  • Attitude of Health Personnel*
  • Decision Making
  • Federal Government
  • Female
  • Hospitals, Veterans*
  • Humans
  • Male
  • Middle Aged
  • Moral Obligations
  • Patient Education as Topic
  • Physician's Role
  • Physician-Patient Relations*
  • Physicians / psychology*
  • Surveys and Questionnaires
  • United States