Advance directive decision making among medical inpatients

Andrea J. Rein, Dana L. Harshman, Trisha Frick, Jean M. Phillips, Shirley Lewis, Marie T. Nolan

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Per the Patient Self-Determination Act of 1991, hospitals are required to ascertain whether patients have an advance directive (AD). At this point, factors prompting patients to issue ADs have not been studied. The purpose of this study was to describe patients' understanding of ADs as well as the process patients used to arrive at their decisions to implement an AD. A stratified random sample of 26 patients from two intensive care units, one general medical unit, one general cardiac unit, and one acquired immunodeficiency unit were selected for participation. Patients were asked a series of open-ended questions to determine their knowledge and understanding of ADs. The constant comparative method was used to review the transcripts. It was found that only 31 per cent of patients had issued an AD, and 20% had learned of ADs for the first time during their hospitalization. Response analysis showed four phases of AD decision making: evaluation of illness, establishment of priorities, consideration of implications of the directives, and selection or rejection of directives. In conclusion, patients continue to have limited understanding of ADs and their implications. Continued investigation will elucidate the best strategies to educate patients about this topic.

Original languageEnglish (US)
Pages (from-to)39-46
Number of pages8
JournalJournal of Professional Nursing
Issue number1
StatePublished - Jan 1 1996


  • Advance directives
  • Durable power of attorney
  • Living wills
  • Patient Self Determination Act

ASJC Scopus subject areas

  • General Nursing


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