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Dialysis Patients' Preferences for Family-Based Advance Care Planning

Stephen C. Hines, PhD; Jacqueline J. Glover, PhD; Jean L. Holley, MD; Austin S. Babrow, PhD; Laurie A. Badzek, RN, JD; and Alvin H. Moss, MD
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From West Virginia University, Morgantown, West Virginia; University of Rochester School of Medicine, Rochester, New York; and Purdue University, West Lafayette, Indiana.

Ann Intern Med. 1999;130(10):825-828. doi:10.7326/0003-4819-130-10-199905180-00016
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Background: Most patients do not participate in advance care planning with physicians.

Objective: To examine patients' preferences for involving their physicians and families in advance care planning.

Design: Face-to-face interviews with randomly selected patients.

Setting: Community-based dialysis units in one rural and one urban region.

Participants: 400 hemodialysis patients.

Measurements: Questions about whom patients involve in advance care planning, whom patients would like to include in this planning, and patients' reactions to state legislation on surrogate decision makers in end-of-life care.

Results: Patients more frequently discussed preferences for end-of-life care with family members than with physicians (50% compared with 6%; P < 0.001). More patients wanted to include family members in future discussions of advance care planning than wanted to include physicians (91% compared with 36%; P < 0.001). Patients were most comfortable with legislation that granted their family end-of-life decision-making authority in the event of their own incapacity (P < 0.001).

Conclusion: Most patients want to include their families more than their physicians in advance care planning.





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