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Kent W. Davidson, MD; Chris Hackler, PhD; Delbra R. Caradine, MD; Ronald S. McCord, MD

JAMA. 1989;262(17):2415-2419.

Abstract
Advance directives provide means for competent individuals to influence treatment decisions in the event of serious illness and subsequent loss of competence, the "living will" being the best known example. Physicians in Arkansas who were identified to be currently engaged in general practice, family medicine, or internal medicine, including its subspecialties (N = 1293), were surveyed to assess attitudes toward and experiences with advance directives. Almost 80% of all respondents expressed a positive attitude and fewer than 2% expressed a negative attitude toward such documents. A majority (55.9%) had actual experience with the instruments in their practices, and 83.5% of these physicians said that their attitude had become more positive as a result of their experience. More frequent employment of advance directives in critical situations was associated with more positive attitudes and experiences. Most of the benefits claimed for advance directives—improved communication and trust, easier and more confident treatment decision, less stress and guilt, and promotion of patient autonomy—were substantiated by the results.

(JAMA. 1989;262:2415-2419)

Author Affiliations
From the Department of Family and Community Medicine (Drs Davidson and McCord) and Division of Medical Humanities (Dr Hackler), University of Arkansas for Medical Sciences; and the Geriatrics Section, Department of Medicine, John L. McClellan Veterans Administration Medical Center, Little Rock, Ark (Dr Caradine). Dr Caradine is currently engaged in private practice in Little Rock, Ark.

Footnotes
Reprint requests to the Department of Family and Community Medicine, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 530, Little Rock, AR 72205 (Dr Davidson).

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