Issues for




to lead


Advanced age

Surrogate decisionmaker

Determine status and location of durable power of attorney documents

C, P, F



Discuss and document preferences for end-of-life care and make arrangements as appropriate

C, P, F



Discuss hopes and expectations for the last stage of life

C, P


Contingency plans

Make specific plans for likely complications and urgent situations

C, F

NOTE: C, caregiver, P, patient; F, family. SOURCE: Adapted from Teno and Lynn, 1966.

  • patient and family socioeconomic characteristics. Some research suggests that those most likely to have an advance directive are white, elderly, educated, and tend to plan for the future. For example, one study found that 34 percent of people with estate wills also had advance directives, while only 7 percent of those without estate wills had such directives (Sachs, 1994). Another report indicated that African Americans and Hispanic Americans were less willing than others studied to complete advance directives (Caralis et al., 1993).2
  • clinician characteristics and clinician-patient relationship. Little specific appears to be documented about clinician characteristics associated with greater or lesser discussion and acceptance of patient goals and preferences for end-of-life care. For example, the SUPPORT study found that only about 60 percent of the physicians who had received information on patient prognosis actually reported that they had the information and only about a third recalled receiving information on patient preferences, but the investigators did not report data on physician characteristics linked to these


In some cultures, the value clash may be acute. For example, a small study of Navajos found that 86 percent believed that talking about advance directives is a "dangerous violation of traditional Navajo values and ways of thinking" (Advance Care Planning Conflicts with Navajo Values, in Advances/A Bridge, Issue 1, page 6, 1996).

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