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Text
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<a href="http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=1524334&site=ehost-live&scope=site" target="_blank" rel="noreferrer">http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=1524334&site=ehost-live&scope=site</a>
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Title
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Effects of offering advance directives on medical treatments and costs
Publisher
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Annals Of Internal Medicine
Date
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1992
Subject
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Humans; Personal Autonomy; Withholding Treatment; Prospective Studies; California; Hospitals; Empirical Approach; Professional Patient Relationship; Death and Euthanasia; DNAR Outcomes; Resource Allocation; Health Care and Public Health; Veterans; University; Advance Directives/ec [Economics]; Advance Directives/psychology; California Durable Power of Attorney for Health Care; Control Groups; Cost Control/methods; Life Support Care/utilization; Life Support Care/economics; Patient Satisfaction/statistics & numerical data; Risk Assessment
Creator
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Schneiderman LJ; Kronick R; Kaplan RM; Anderson JP; Langer RD
Description
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Objective: To examine the effects of advance directives on medical treatments and on patient satisfaction and well-being and to determine whether the enhancement of patient autonomy through advance directives provides a more ethically feasible approach to cost control than does the imposition of limits through rationing.; Design: Randomized, controlled trial.; Setting: University and Veterans Affairs medical center.; Patients: Two hundred and four patients with life-threatening illnesses, 100 of whom died after enrollment in the study.; Intervention: Patients randomly assigned to the experimental group were offered the California Durable Power of Attorney (a typical proxy-instruction directive), and patients assigned to the control group were not offered the advance directive. Hospital admissions were monitored to assure that a summary of the document was present in the active medical record at each hospitalization.; Measurements: Cognitive function, patient satisfaction, psychological well-being, health locus of control, sense of coherence, health-related quality of life, receipt of medical treatments, and medical treatment charges.; Results: No significant differences were found between advance-directive and control groups regarding psychosocial variables, health outcome variables, and medical treatments or charges. Patients offered an advance directive had an average hospital stay of 40.8 days (95% CI, 32.2 to 49.4 days), compared with an average of 33.1 days (95% CI, 26.0 to 40.2 days) for controls. Patients offered an advance directive were charged an average of $19,502 (95% CI, $13,030 to $25,974) for medical treatments in the last month of life compared with $19,700 (95% CI, $13,704 to $25,696) for controls.; Conclusions: Despite claims that public demand for longer life accounts for rising medical costs, most surveys suggest that patients are calling for less, not more, of the expensive, high-technology treatment often used in terminal phases of illness. Executing the California Durable Power of Attorney for Health Care and having a summary copy placed in the patient's medical record had no significant positive or negative effect on a patient's well-being, health status, medical treatments, or medical treatment charges.;
1992-10
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
1992
Advance Directives/ec [Economics]
Advance Directives/psychology
Anderson JP
Annals Of Internal Medicine
Backlog
California
California Durable Power of Attorney for Health Care
Control Groups
Cost Control/methods
Death and Euthanasia
DNAR Outcomes
Empirical Approach
Health Care and Public Health
Hospitals
Humans
Journal Article
Kaplan RM
Kronick R
Langer RD
Life Support Care/economics
Life Support Care/utilization
Patient Satisfaction/statistics & Numerical Data
Personal Autonomy
Professional Patient Relationship
Prospective Studies
Resource Allocation
Risk Assessment
Schneiderman LJ
University
Veterans
Withholding Treatment