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Advance Directives

Journal Article
Evaluating the Pragmatic Characteristics of Advance Care Planning Outcome Measures in Dementia Clinical Trials: A Scoping Review
In this review of ACP RCTs enrolling PLWD or their care partners, we found that the majority of outcome measures were not highly pragmatic in nature and had high data capture burden, but over half were highly relevant to PLWD or their care partners.
Jul 31, 2023
Journal Article
Advance Care Planning Among Sexual Minority Men: Sociodemographic, Health Care, and Health Status Predictors
There is a dearth of contemporary information about advance care planning among sexual minority men, a population with disparities in health care and health status. We sought to address some of these gaps in a large, longitudinal cohort.
Jun 21, 2023
Journal Article
Care Preferences in Physician Orders for Life Sustaining Treatment in California Nursing Homes
Physician Orders for Life-Sustaining Treatment (POLST) facilitates documentation and transition of patients' life-sustaining treatment orders across care settings. We describe the orders within POLST among all nursing home residents in California from 2011 to 2016.
Mar 16, 2022
Journal Article
POLST Completion and Continuity in California Nursing Homes
We used MDS 2011–2016 linked to California Section S to describe POLST completion, cardiopulmonary resuscitation and do not resuscitate orders, invalid POLST documents, and switches in POLST content across the population of California NH residents.
Mar 16, 2022
Journal Article
The Role of Regional and State Initiatives in Nursing Home Advance Care Planning Policies
We examined whether state and regional advance care planning initiatives play a role in the presence of "do not administer antibiotics" orders for nursing home residents at the end of life.
Apr 7, 2021
Journal Article
Individual, Interpersonal, and Health Care Factors Associated with Informal and Formal Advance Care Planning in a Nationally-Representative Sample of Midlife and Older Adults
This paper examines correlates of advance care planning among midlife and older adults in the U.S., with attention to informal planning (e.g., conversations) and formal planning (e.g., legal documentation) and factors at the individual, interpersonal, and health care levels.
Mar 31, 2021
Journal Article
Beyond the Hour of Death: Family Experiences of Grief and Bereavement Following an End-of-Life Hospitalization in the Intensive Care Unit
This article examines bereaved family members' experiences of grief by examining three aspects from the end-of-life hospitalization and decision-making in the ICU that informed their subsequent bereavement experiences.
Sep 3, 2020
Journal Article
Negotiating the 'Buffet' of Choice: Advances in Technology and End-of-Life Decision-Making in the Intensive Care Unit Setting
This article explores medical decision-making in the setting of the intensive care unit (ICU) drawing on ethnographic data of ICUs as well as interviews with family members of critically ill patients as and clinicians.
Sep 3, 2020
Commentary
COVID-19 and End-of-Life Decisions
Resuscitative efforts do not typically save a life. In anticipation of the pandemic surge, hospitals are discussing blanket do-not-resuscitate orders for patients dying from the coronavirus. It's time to discuss the limits of CPR so patients stricken with COVID-19 can make informed end-of-life decisions.
Apr 30, 2020
Journal Article
End-of-Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities
About 60 % of Accountable Care Organizations (ACOs) have some kind of end-of-life care planning processes in place, but only about 20% have established advanced planning processes.
Jul 18, 2017
Journal Article
The Lack of Documentation of Preferences in a Cohort of Adults Who Died After Ischemic Stroke
Stroke patients' wishes to limit life-sustaining interventions were documented in less than 40 percent of cases in which patients died 30 days after hospital admission.
Apr 22, 2016
Journal Article
A Hospital-Based Advance Care Planning Intervention for Patients with Heart Failure: A Feasibility Study
The purpose of this study was to evaluate the feasibility of implementing a multiple-component hospital-based intervention on completion of ACP forms among HF patients.
Feb 18, 2016
Journal Article
Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer
Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer.
Jul 28, 2015
Journal Article
The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care
Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit.
Apr 29, 2015
Blog
When CPR Is the Wrong Call: Mistaking Medical Treatment for Care
If a medical treatment worked only a fraction of the time and resulted in bad outcomes more often than not, practitioners would not make this treatment the default approach. Yet that is exactly what has happened when it comes to CPR for individuals 85 years and older who suffer cardiac arrest in a community setting.
Mar 14, 2013
Journal Article
The Impact of Late-Life Parental Death on Adult Sibling Relationships: Do Parents' Advance Directives Help or Hurt?
The authors examined whether the effect of parental death on adults siblings' relationship quality varies on the basis of the presence and perceived effectiveness of a deceased parent's formal preparations for end-of-life care.
Jan 1, 2009
Journal Article
Inter-vivos Giving By Older People in the United States: Who Received Financial Gifts from the Childless?
Using data for 1996 to 2004 from the United States Health and Retirement Study, this article examines the differences between parents and childless older people in financial transfers to people other than their children.
Jan 1, 2009
Journal Article
Evidence for Improving Palliative Care at the End of Life: A Systematic Review
Assesses evidence about interventions to improve palliative and end-of-life care.
Jan 1, 2008
Journal Article
Advance Care Planning Among the Oldest Old
Even in a system known for high-quality chronic illness care, documentation of advance care planning and proxies for health decisions at end of life was infrequent. Involvement of outpatient primary care and geriatric providers may improve care.
Jan 1, 2008
Journal Article
Use of Advance Directives for Nursing Home Residents in the Emergency Department
Finds variability in advance directive documentation for nursing home patients on transfer to the emergency department, and finds that emergency clinicians experience substantial difficulty in reliably obtaining information about advance directives.
Jan 1, 2008

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RAND Topic:
Advance Directives

Research conducted by

RAND Health Care

Researcher Spotlight

Daniel Siconolfi

Behavioral and Social Scientist

Daniel Siconolfi (he/him) is a behavioral scientist at the RAND Corporation. His research portfolio addresses health disparities, healthy aging, and access to home and community-based services with focal populations including sexual and gender minority persons, older adults, persons living with…
Julia Bandini

Behavioral and Social Scientist

Julia Bandini is a behavioral and social scientist at RAND and a professor of policy analysis at the Pardee RAND Graduate School. Her research centers around care for vulnerable and seriously-ill individuals including end-of-life care, palliative and hospice care, and advance care planning. She…

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