Could lack of clarity in written advance directives contribute to their ineffectiveness? A study of the content of written advance directives

Since 1991, advance directives have failed to have a significant impact on end of life care. One reason is that despite widespread interest in these documents, few individuals have chosen to issue advance directives. Another reason reported in several studies is that the conditions under which the patient intended the directives to apply are unclear as are some of the treatments requested or declined. The purpose of this study was to describe instructions commonly included in written advance directives concerning the conditions under which the directives should apply and the treatments that are requested or declined. Five hundred consecutive closed medical records were reviewed from the medical and surgical departments of an urban hospital. These records produced 40 (8%) advance directive documents. Patient instructions indicating when the directives should take effect and which treatments should be declined or provided were summarized. Nurses and other health professionals can use this information to assist in patients in making their advance directives as clear as possible and to make patients more aware of the potential limitations of these types of written instructions.