How Physicians Communicate about Advance Directives
Authors: James A. Tulsky
Journal: Annals of Internal Medicine (1999)

Letters4 May 1999How Physicians Communicate about Advance DirectivesJames A. Tulsky, MD, Gary S. Fischer, MD, and Robert M. Arnold, MDJames A. Tulsky, MDDurham Veterans Affairs Medical Center; Duke University; Durham, NC 27705 (Tulsky)University of Pittsburgh; Pittsburgh, PA 15213 (Fischer)University of Pittsburgh; Pittsburgh, PA 15213 (Arnold)Search for more papers by this author, Gary S. Fischer, MDDurham Veterans Affairs Medical Center; Duke University; Durham, NC 27705 (Tulsky)University of Pittsburgh; Pittsburgh, PA 15213 (Fischer)University of Pittsburgh; Pittsburgh, PA 15213 (Arnold)Search for more papers by this author, and Robert M. Arnold, MDDurham Veterans Affairs Medical Center; Duke University; Durham, NC 27705 (Tulsky)University of Pittsburgh; Pittsburgh, PA 15213 (Fischer)University of Pittsburgh; Pittsburgh, PA 15213 (Arnold)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-9-199905040-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Leff that our study does not prove that improving the quality of advance directive discussions will be sufficient to increase their effectiveness. Other factors, ranging from problems with the portability of directives to insufficient institutional incentives for implementing directives, may well be contributing to their lack of effectiveness. However, when only 25% of discussions mention the use of artificial nutrition and hydration or only 55% mention uncertainty, it is not a mere leap of faith to suggest that many of these discussions will not aid physicians faced with such decisions in the future. Furthermore, ...References1. Fischer GS, Tulsky JA, Rose MR, Siminoff LA, Arnold RM. Patient knowledge and physician predictions of treatment preferences after discussion of advance directives. J Gen Intern Med. 1998;13:447-54. CrossrefMedlineGoogle Scholar2. Maguire P, Booth K, Elliott C, Jones B. Helping health professionals involved in cancer care acquire key interviewing skills—the impact of workshops. Eur J Cancer. 1996;32A:1486-9. CrossrefMedlineGoogle Scholar3. Parle M, Maguire P, Heaven C. The development of a training model to improve health professionals' skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med. 1997;44:231-40. CrossrefMedlineGoogle Scholar4. Levinson W, Roter D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993;8:318-24. CrossrefMedlineGoogle Scholar5. Emanuel LL. Structured advance planning: is it finally time for physician action and reimbursement? JAMA. 1995;274:501-3. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Durham Veterans Affairs Medical Center; Duke University; Durham, NC 27705 (Tulsky)University of Pittsburgh; Pittsburgh, PA 15213 (Fischer)University of Pittsburgh; Pittsburgh, PA 15213 (Arnold) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOpening the Black Box: How Do Physicians Communicate about Advance Directives? James A. Tulsky , Gary S. Fischer , Mary R. Rose , and Robert M. Arnold How Physicians Communicate about Advance Directives Bruce Leff How Physicians Communicate about Advance Directives Jean R. Pascoe Metrics 4 May 1999Volume 130, Issue 9Page: 781KeywordsDisabilitiesForecastingMedical educationMotivationNutritionPatients Issue Published: 4 May 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...