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Accuracy of Primary Care and Hospital-Based Physicians' Predictions of Elderly Outpatients' Treatment Preferences With and Without Advance Directives
Kristen M. Coppola, PhD;
Peter H. Ditto, PhD;
Joseph H. Danks, PhD;
William D. Smucker, MD
Arch Intern Med. 2001;161:431-440.
Background Past research has documented that primary care physicians and family
members are often inaccurate when making substituted judgments for patients
without advance directives (ADs). This study compared the accuracy of substituted
judgments made by primary care physicians, hospital-based physicians, and
family surrogates on behalf of elderly outpatients and examined the effectiveness
of ADs in improving the accuracy of these judgments.
Participants and Methods Participants were 24 primary care physicians of 82 elderly outpatients,
17 emergency and critical care physicians who had no prior experience with
the patients, and a baseline comparison group of family surrogates. The primary
outcome was accuracy of physicians' predictions of patients' preferences for
4 life-sustaining treatments in 9 hypothetical illness scenarios. Physicians
made substituted judgments after being provided with no patient AD, patient's
value-based AD, or patient's scenario-based AD.
Results Family surrogates' judgments were more accurate than physicians'. Hospital-based
physicians making predictions without ADs had the lowest accuracy. Primary
care physicians' accuracy was not improved by either AD. Accuracy and confidence
in predictions of hospital-based physicians was significantly improved for
some scenarios using a scenario-based AD.
Conclusions Although ADs do not improve the accuracy of substituted judgments for
primary care physicians or family surrogates, they increase the accuracy of
hospital-based physicians. Primary care physicians are withdrawing from hospital-based
care in growing numbers, and emergency medicine and critical care specialists
most often are involved in decisions about whether to begin life-sustaining
treatments. If ADs can help these physicians better understand patients' preferences,
patient autonomy more likely will be preserved when patients become incapacitated.
From the Department of Psychology, Monmouth University, West Long Branch,
NJ (Dr Coppola); Department of Psychology and Social Behavior, University
of California, Irvine (Dr Ditto); Department of Psychology, Kent State University,
Kent, Ohio (Dr Danks); and Department of Family Practice, Summa Health System,
Akron, Ohio (Dr Smucker).
Corresponding author and reprints: Kristen M. Coppola, PhD, Department
of Psychology, Monmouth University, West Long Branch, NJ 07764 (e-mail: kcoppola{at}monmouth.edu) or Peter H. Ditto, PhD, Psychology and Social
Behavior, 3340 Social Ecology II, University of California, Irvine, Irvine,
CA 92697-7085 (e-mail: phditto{at}uci.edu).
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