ABSTRACT
PURPOSE: Advance directives can assist in end-of-life decision-making. This study explores the factors that influence completion of advance directives. METHODS: Qualitative study using in-depth interviews of 10 patients over age 60 in a rural office practice. RESULTS: Major themes: (1) patient autonomy: the patient and family role as decision maker, the physician as educator; (2) barriers that deter patients from completing advance directives include fear and confusion about these documents; and (3) quality of life is an important value in end-of-life decision-making. CONCLUSIONS: Decision making about advance directives is a personal and family issue, but physician efforts to initiate the process and educate patients are important, especially if done routinely in the office or preferably in community settings. The main difference between those who do and don't complete advance directives is an understanding of the documents and their purpose.
