Understanding Advance Directives in Elective Surgery

Significance of Advance Directives

Recent research has revealed how many patients articulate their medical wishes through advance directives (AD) prior to undergoing elective surgery, particularly in emergency situations. An advance directive is a legal document activated when a patient is unable to communicate their preferences for medical treatment. This document is crucial not only for elderly patients but also for anyone facing elective surgery, as it addresses potential complications during the procedure. It allows patients to specify their preferences regarding life-sustaining treatments, such as mechanical ventilation and cardiopulmonary resuscitation (CPR), and appoint someone to make decisions on their behalf if necessary.

Current Situation in Medical Practice

Often, patients scheduled for surgery do not possess an advance directive, leaving physicians to contact family members to make difficult decisions regarding the patient’s care. There can be a disconnect between the choices made by family members and the patient’s actual preferences for treatment.

Research Findings on Advance Directives

Study Overview

Researchers from the Regenstrief Institute, Indiana University Health, and Indiana University School of Medicine conducted a study to assess the prevalence of advance directives among patients undergoing preoperative evaluations and the accessibility of these documents within electronic medical records (EMR). The findings were published in the Journal of General Internal Medicine.

Key Results

The lead researcher, Dr. Shilpee Sinha, along with her colleagues, analyzed data from 400 patients assessed at two high-volume hospitals over 1.5 months. They discovered that 30% of the participants had some form of advance directive, with a higher prevalence among patients aged 65 and older and those with chronic heart conditions such as congestive heart failure. However, only 16% of these directives were scanned into the EMR, which is vital for ensuring that healthcare providers can access the document during surgery when needed.

Implications of the Study

Although this research was conducted at a single hospital site, it may not reflect the situation across all healthcare facilities. Nevertheless, the investigators aim to use these findings to promote advanced care planning. Dr. Sinha commented, “One of my goals for doing this study is to drive clinical change. The discussion of advance care planning is not part of the established routine. I think we’ve achieved buy-in on the idea of having these conversations. Now we need actual logistical application.”

References

Sinha, S., Gruber, R., Cottingham, A., Nation, B., Lane, K., Bo, N. and Torke, A. (2019). Advance Care Planning in A Preoperative Clinic: A Retrospective Chart Review. Journal of General Internal Medicine, 34(4), pp.523-525.

EurekAlert!. (2019). Study shows 70% of patients lack advance directives before elective surgery. [online] Available at: https://www.eurekalert.org/pub_releases/2019-06/ri-ss7061719.php [Accessed 18 Jun. 2019].