Advance directives are more likely among seniors asked about end-of-life care preferences.

Abstract

SINCE the implementation of the Patient Self-Determination Act in December 1991, health maintenance organizations (HMOs) and other health care institutions have been required to inform all adult patients about advance directives (ADs) and hospitals have been required to ask all patients whether they have completed ADs. Presence of an AD or documentation in the medical record that patients have been advised about ADs has become a quality indicator for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). While public support for ADs is high, surveys conducted shortly after the implementation of the Patient Self-Determination Act in December 1991 have shown that a relatively small proportion of adults in the United States have an AD.^1-3