The Gerontologist
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hawkins, N. A.
Right arrow Articles by Smucker, W. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hawkins, N. A.
Right arrow Articles by Smucker, W. D.
The Gerontologist 45:107-117 (2005)
© 2005 The Gerontological Society of America

Micromanaging Death: Process Preferences, Values, and Goals in End-of-Life Medical Decision Making

Nikki Ayers Hawkins, PhD1, Peter H. Ditto, PhD1,, Joseph H. Danks, PhD2 and William D. Smucker, MD3

Correspondence: Address correspondence to Peter H. Ditto, PhD, Department of Psychology and Social Behavior, University of California, Irvine, 3340 Social Ecology II, Irvine, CA 92697-7085. E-mail: phditto{at}uci.edu

Purpose: This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a longitudinal study designed to investigate psychological assumptions underlying the use of advance directives. Three-hundred thirty-seven outpatients aged 65 and older and their designated surrogate decision makers completed interviews and questionnaires. Results: Very few individuals wished to document specific medical treatment preferences and mandate that they be followed, without exception, near death. Most desired to express more general preferences, such as values and goals for care, in addition to (or, instead of) specific treatment preferences and to allow surrogate decision makers leeway in decision making. Patient-to-patient variability with regard to process preferences was substantial, as was surrogates' misunderstanding of the patients' process preferences. Implications: Very few individuals may desire the standard approach to advance care planning whereby preferences for specific life-sustaining treatments are documented and these requests are strictly followed near death. Instead, patient autonomy may be better served by emphasizing discussion of process preferences and leeway in decision making.

Key Words: Advance medical directives • Surrogate decision makers • Medical treatment preferences




This article has been cited by other articles:


Home page
Palliat MedHome page
R. Jox, M Krebs, J Bickhardt, K Hessdorfer, S Roller, and G. Borasio
How strictly should advance decisions be followed? The patients' opinion
Palliative Medicine, July 1, 2008; 22(5): 675 - 676.
[PDF]


Home page
ANN INTERN MEDHome page
J. T. Berger, E. G. DeRenzo, and J. Schwartz
Surrogate Decision Making: Reconciling Ethical Theory and Clinical Practice
Ann Intern Med, July 1, 2008; 149(1): 48 - 53.
[Abstract] [Full Text] [PDF]


Home page
QJMHome page
S. Workman
A communication model for encouraging optimal care at the end of life for hospitalized patients
QJM, December 1, 2007; 100(12): 791 - 797.
[Abstract] [Full Text] [PDF]


Home page
Journal of Family NursingHome page
Y. Y. Colclough and H. M. Young
Decision Making at End of Life Among Japanese American Families
Journal of Family Nursing, May 1, 2007; 13(2): 201 - 225.
[Abstract] [PDF]


Home page
Arch Intern MedHome page
A. E. Volandes, L. S. Lehmann, E. F. Cook, S. Shaykevich, E. D. Abbo, and M. R. Gillick
Using Video Images of Dementia in Advance Care Planning
Arch Intern Med, April 23, 2007; 167(8): 828 - 833.
[Abstract] [Full Text] [PDF]


Home page
AJGPHome page
K. B. Hirschman, J. M. Kapo, and J. H.T. Karlawish
Why Doesn't a Family Member of a Person With Advanced Dementia Use a Substituted Judgment When Making a Decision for That Person?
Am J Geriatr Psychiatry, August 1, 2006; 14(8): 659 - 667.
[Abstract] [Full Text] [PDF]


Home page
Arch Intern MedHome page
T. R. Fried, A. L. Byers, W. T. Gallo, P. H. Van Ness, V. R. Towle, J. R. O'Leary, and J. A. Dubin
Prospective Study of Health Status Preferences and Changes in Preferences Over Time in Older Adults.
Arch Intern Med, April 24, 2006; 166(8): 890 - 895.
[Abstract] [Full Text] [PDF]


Home page
GerontologistHome page
S. Zimmerman, P. D. Sloane, C. S. Williams, P. S. Reed, J. S. Preisser, J. K. Eckert, M. Boustani, and D. Dobbs
Dementia Care and Quality of Life in Assisted Living and Nursing Homes
Gerontologist, October 1, 2005; 45(suppl_1): 133 - 146.
[Abstract] [Full Text] [PDF]


Home page
BMJHome page
Minerva
BMJ, February 26, 2005; 330(7489): 488 - 488.
[Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2005 by The Gerontological Society of America.