Experts practice what they preach: A descriptive study of best and normative practices in end-of-life discussions

Debra Roter, Susan M Larson, Gary S. Fischer, Robert M. Arnold, James A. Tulsky

Research output: Contribution to journalArticle

Abstract

Background: Advance directives (ADs) are widely regarded as the best available mechanism to ensure that patients' wishes about medical treatment at the end of life are respected. However, observational studies suggest that these discussions often fail to meet their stated goals. Objectives: To explore best practices by describing what physicians who are considered expert in the area of end-of-life bioethics or medical communication do when discussing ADs with their patients and to explore the ways in which best practices of the expert group might differ in content or style from normative practice derived from primary care physicians' discussions of ADs with their patients collected as part of an earlier study. Design: Nonexperimental, descriptive study of audio-taped discussions. Setting: Outpatient primary care practices in the United States. Participants: Eighteen internists who have published articles in the areas of bioethics or communication and 48 of their patients. Fifty-six academic internists and 56 of their established patients in 5 practice sites in 2 locations - Durham, NC, and Pittsburgh, Pa. Eligible patients were at least 65 years old or suffered from serious medical illness and had not previously discussed ADs with their physician. Expert clinicians had discretion regarding patient selection, while the internists chose patients according to a predetermined protocol. Measurements: Coders applied the Roter Interaction Analysis System (RIAS) to audiotapes of the medical visits to describe communication dynamics. In addition, the audiotapes were scored on 21 items reflecting physician performance in specific skills related to AD discussions. Results: Experts spent close to twice as much time (14.7 vs 8.1 minutes, P

Original languageEnglish (US)
Pages (from-to)3477-3485
Number of pages9
JournalArchives of Internal Medicine
Volume160
Issue number22
StatePublished - Dec 11 2000

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Practice Guidelines
Advance Directives
Tape Recording
Bioethics
Communication
Physicians
Primary Care Physicians
Ambulatory Care
Patient Selection
Observational Studies
Primary Health Care

ASJC Scopus subject areas

  • Internal Medicine

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Experts practice what they preach : A descriptive study of best and normative practices in end-of-life discussions. / Roter, Debra; Larson, Susan M; Fischer, Gary S.; Arnold, Robert M.; Tulsky, James A.

In: Archives of Internal Medicine, Vol. 160, No. 22, 11.12.2000, p. 3477-3485.

Research output: Contribution to journalArticle

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