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 Patient Advocacy in the ICU Robert McCarthy January 2000 PulmonaryReviews.com www.pulmonaryreviews.com/jan00/pr_jan00_patientadvocacy.html Studies have shown that only 10% to 25% of patients entering an acute care setting have outlined even the most rudimentary advance directive. What is much worse than the lack of advance directives is the fact that even when such directives exist, they tend not to be followed. "In one study of 4,804 geriatric patients, 688 of them (14.3%) had some form of advance directive," said Dr. Terry. "But the majority were so vague as to be virtually meaningless. Only 90 were felt to be specific enough to be testable, in the sense that the patient could be followed to determine whether or not the advance directive had been adhered to. Of those 90, 22 patients' end-of-life situations were putatively governed by the advance directive. But the directives were followed in only nine cases. Not a very encouraging figure." "There are studies that show families tend to favor more aggressive treatment - more aggressive than the patient would have selected and, often, much more aggressive than the physician would recommend," Dr. Terry explained. "Families are demanding that the most aggressive, heroic measures be undertaken, while the physician is pointing out that such measures may be futile, that they will produce no benefit," he said.  |
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