ABSTRACT
OBJECTIVE: To examine one model of research advance directive as a possible way to reduce the mismatch between patient and proxy choices and also to learn more about how patients with mild to moderate dementia may want to keep decision making or cede it to their proxies in the future. METHODS: Separate interviews were conducted with 149 dyads of dementia patients and family proxies about future enrollment in five types of research. Subsequent joint interviews were conducted with 69 of those dyads to discuss their separately articulated decisions and ask whether the patient prefers future enrollment decisions to be made as he or she directs today or as the proxy deems best in the future. RESULTS: Patients chose to cede future decision making to their proxies in 82.9% of the trials. Patients ceded decisions to their proxies in 80.7% of those trials about which the dyad had given opposite answers (n = 74, 49.7%). Patients who had expressed discomfort about the prospect of the proxy making an enrollment decision in a trial (n = 49, 32.9%) ceded decision making to their proxies in 45.7% of those trials. CONCLUSIONS: Both patients and proxies were willing to discuss future research enrollment in the context of an advance directive for research. Such a document may be helpful to proxies and researchers in the future to judge the types of research and associated risks patients are willing to enroll in. Although most patients willingly cede future decisions to their proxies, a sizeable minority do not wish to do so.
Subject(s)
Advance Directives , Clinical Trials as Topic/psychology , Decision Making , Dementia/psychology , Mental Competency , Patients/psychology , Proxy , Third-Party Consent , Administration, Oral , Advance Directives/ethics , Advance Directives/psychology , Black or African American/psychology , Aged , Aged, 80 and over , Brain , Clinical Trials as Topic/ethics , Communication , Drug Evaluation, Preclinical/psychology , Female , Genetic Testing/psychology , Humans , Interpersonal Relations , Male , Middle Aged , Patient Rights , Personal Autonomy , Phlebotomy/psychology , Psychological Tests , Risk , Spinal Puncture/psychology , Stem Cell Transplantation/psychology , White People/psychologyABSTRACT
Handwritten autobiographies from 180 Catholic nuns, composed when participants were a mean age of 22 years, were scored for emotional content and related to survival during ages 75 to 95. A strong inverse association was found between positive emotional content in these writings and risk of mortality in late life (p < .001). As the quartile ranking of positive emotion in early life increased, there was a stepwise decrease in risk of mortality resulting in a 2.5-fold difference between the lowest and highest quartiles. Positive emotional content in early-life autobiographies was strongly associated with longevity 6 decades later. Underlying mechanisms of balanced emotional states are discussed.
