Accuracy of a decision aid for advance care planning

Simulated end-of-life decision making

Benjamin Levi, Steven R. Heverley, Michael Green

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: Advance directives have been criticized for failing to help physicians make decisions consistent with patients' wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients' wishes into treatment decisions. Methods: We recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios. From the three individual physicians' responses, a "consensus physician response" was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions. Results: Patient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR). Across the six vignettes, patient-participants' rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians' overall rating of their confidence at accurately translating patients' wishes into clinical decisions was 7.8 (range = 6.1-9.3,1 = not at all confident, 10 = extremely confident). Conclusion: For simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse.

Original languageEnglish (US)
Pages (from-to)223-238
Number of pages16
JournalJournal of Clinical Ethics
Volume22
Issue number3
StatePublished - Jan 1 2011

Fingerprint

Advance Care Planning
decision aid
Decision Support Techniques
Advance Directives
Decision Making
physician
Physicians
decision making
planning
Consensus
rating
Cardiopulmonary Resuscitation
Artificial Respiration

All Science Journal Classification (ASJC) codes

  • Issues, ethics and legal aspects
  • Health(social science)
  • Health Policy

Cite this

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abstract = "Purpose: Advance directives have been criticized for failing to help physicians make decisions consistent with patients' wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients' wishes into treatment decisions. Methods: We recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios. From the three individual physicians' responses, a {"}consensus physician response{"} was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions. Results: Patient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR). Across the six vignettes, patient-participants' rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians' overall rating of their confidence at accurately translating patients' wishes into clinical decisions was 7.8 (range = 6.1-9.3,1 = not at all confident, 10 = extremely confident). Conclusion: For simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse.",
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Accuracy of a decision aid for advance care planning : Simulated end-of-life decision making. / Levi, Benjamin; Heverley, Steven R.; Green, Michael.

In: Journal of Clinical Ethics, Vol. 22, No. 3, 01.01.2011, p. 223-238.

Research output: Contribution to journalArticle

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