If a patient is no longer able to communicate personally how he or she would like to be treated, doctors and relatives consult an advance directive, if one is available. However, doctors and relatives often interpret patients' written wishes in different ways, as Nadja Leder et al. establish in their original article in the current issue of Deutsches Ärzteblatt International (Dtsch Arztbl Int 112: 723-9).
They conducted a study to investigate the advance directives of 50 nonresponsive intensive care patients: they used interviews and questionnaires to analyze how well treating physicians and patient representatives believed patients' written wishes were being or had been implemented.
Doctors often judge advance directives to be unclearly worded and not applicable to the patient's current situation. For them, advance directives tend to serve as a guideline. Relatives, in contrast, try to implement patients' written wishes literally. They assigned a higher level of validity to advance directives than doctors did. Nevertheless, despite the differences in assessment, almost 70% of relatives stated that patients' wishes had been fully implemented.
In the eyes of the authors, trusting dialogue between treating physicians and patient representatives results in high levels of satisfaction with treatment. Advance directives should be worded more appropriately, however, so that all those involved are of the same opinion regarding their validity.
Programs such as advanced care planning (ACP) may be suitable for this.