If you were in an accident and fell into a coma, would you want to be placed on life-support? For how long? An advance directive is a legal document for exactly this purpose: it indicates your wishes when you are too sick to express them yourself. Despite the importance of such a document, a new study finds that many Americans don’t bother to complete one and also avoid spelling out other end-of-life (EOL) decisions. The new study appears in the American Journal of Preventive Medicine.

"EOL issues need to come to the forefront of planning efforts," Dr. Jaya K. Rao, formerly an associate professor from the University of North Carolina, stated in a press release. "Hopefully, these findings will contribute to the current national conversations about EOL care."

Comfort and Dignity

For the study, investigators analyzed data from the 2009 and 2010 HealthStyles national surveys conducted by the global public relations firm, Porter Novelli. The surveys included questions about advance directives and other EOL topics and included responses from 7,946 participants. The researchers, a team assembled from University of North Carolina and the Centers for Disease Control and Prevention (CDC), found that, overall, 67.8 percent of all respondents had concerns about EOL care, including the cost, the pain they might experience, or their comfort and dignity.

Yet only 26.3 percent of respondents (2,093 people) had completed an advance directive. Women, whites, those with a college degree or postgraduate training, and those who were married, were more likely than others to have completed an advance directive. Although respondents younger than 54 were most likely to report not having advance directives, 31.7 percent of respondents over the age of 55 also reported not having one.

"For black and Hispanic respondents, advance directives were less frequent across all educational groups," Rao explained. “These data indicate racial and educational disparities in advance directive completion and highlight the need for education about their role in facilitating EOL decisions.”

Unsurprisingly, respondents who had completed their advance directives also reported having a chronic disease and a regular source of care in many cases. And among those respondents who had not completed an advance directive, the most frequently cited reason was: “I don’t know what advance directives are” yet second on the list of reasons was “my family knows my wishes.”

"The study provides information from a large sample of adults on their attitudes and behaviors regarding advance directives," Lynda A. Anderson, Ph.D., director of the CDC's Healthy Aging program, stated in a press release. An aging population and an increase in the prevalence of chronic disease among adults over the age of 44 translates into higher Medicare expenditures as well as rising out-of-pocket costs. Past studies have shown that use of advance directives is not only associated with lower levels of Medicare spending but also a lower likelihood of in-hospital death. Preparing to leave the planet may not be the happiest of thoughts, but it might be exactly what's necessary to attain the comfort and dignity you seek. For more information and access to free advance directives for each state, click here.

Source: Anderson LA, Rao JK, Lin F-C, Laux JP. Completion of Advance Directives Among U.S. Consumers. American Journal of Preventive Medicine. 2013.