Advance directives not in place for many

Study shows need for public education

About 66% of respondents to a Maryland telephone survey do not have advance medical directives, according to a new report by researchers from the Johns Hopkins Bloomberg School of Public Health's Department of Health Policy and Management.

Younger adults and African-Americans were less likely than older adults and whites to report having an advance directive, which includes the living will and health care power of attorney. The results will be published in an upcoming issue of Health Policy.

While 34% of all respondents had an advance directive, 61% indicated they have preferences about medical care in the event they are unable to make such decisions. The primary reasons reported for not having an advance directive include being unfamiliar with them, feeling too healthy to need one, or, for the younger adults, being too young to need one. Forty percent of adults surveyed reported that they would like to obtain information on advance medical directives from a physician; however, only 12% of the respondents with advance directives reported obtaining it from their doctor.

"These results support a need for legislative and regulatory changes to increase the number of people with advance directives," said Dan Morhaim, MD, one of the study authors and an adjunct professor with the Bloomberg School's Department of Health Policy and Management and member of the Maryland House of Delegates. "Advance medical directives cost nothing to complete and are readily available from many sources. We need to make sure that people know where to get them and why it's important to complete them."

Research has shown the benefits of advance directives include improved quality at the end-of-life, fewer burdens on family and health care providers, and a reduced need for life-sustaining treatment. Lead study author Keshia Pollack, PhD, MPH, an assistant professor with the Department of Health Policy and Management and the Centers for Injury Research and Policy and Health Disparities Solutions, added, "These findings suggest a disconnect between what people want in the event they are unable to make medical decisions for themselves and their actions to ensure their preferences are actually carried out."

Pollack and colleagues administered a population-based cross-sectional telephone survey to 1,195 adult Maryland residents. In addition to being asked whether they have an advance directive, respondents were asked where they had received information on them and where they would like to receive such information. "While these results are specific to Maryland, they are relevant to other areas of the country with the factors that lead to or hinder completion of advance directives," said Pollack.