New Advance Directive Study: Useful Findings but Confusing Reporting

An important new study about advance directives was just released October 5 in the Journal of the American Medical Association (JAMA). You and your clients may have already heard about this in the news.

The study’s findings are generally favorable (and certainly not unfavorable) toward advance directives. But — some of the press coverage has the potential to confuse clients or cause them concern about the purpose of the advance directives that you helped them create. Specifically, some of the coverage describes advance directives as a “cost-saving measure” or as “not effective.”  

Here are some of the main points from the JAMA study that may be important for your firm and your clients to understand should clients ask you about this study:

1. This study looked at patients who wanted less aggressive treatment at the end of their lives. It used cost of care as the proxy measure of the treatment received, hence the reporting focus on costs.
2. The findings suggest that people with advance directives who wanted less aggressive end-of-life care did have their wishes met. Specifically:
   

   • this group of patients did not have everything medically possible done for them, as measured by their lower costs of care.

   • these patients had a higher rate of dying outside the hospital (a measure of less aggressive care)

   • these patients had higher rates of using hospice and palliative care (comfort and pain management) services

3. In certain areas of the country, advance directives helped patients achieve their goal of less aggressive treatment. In other areas, advance directives were not necessary for people to have their wishes met because of less aggressive treatment norms there.
4. The study did not find or even suggest that advance directives were used as a cost-cutting measure. Nor does it suggest that patients received less care than they wanted for any reason. In fact, the study did not evaluate the care of patients who specifically stated in their advance directives that they wanted the most aggressive treatment possible (to determine if advance directives helped them achieve this goal).

In closing, this study suggests that having advance directives either helped or at worst had no effect on patients getting the less aggressive care that they wanted at the end of their lives. It did not find that advance directives were counterproductive to these patients receiving their desired care.

If you have any questions about this study or its meaning for your clients, please feel free to call me at 610-667-3524 or email me at rsiegel@docubank.com.

Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), the largest advance directive registry in the U.S., which ensures that the healthcare directives of its 190,000 enrollees are immediately available 24/7/365. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. She is active in health policy pertaining to advance directives and serves as a Senior Fellow at the Jefferson School of Population Health in Philadelphia. Randi is an ongoing contributor to the Academy blog.

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