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  1. Opening the black box : How do physicians communicate about advance directives ?

    Article - En anglais


    The quality of communication that leads to the completion of written advance directives may influence the usefulness of these documents, but the nature of that communication remains relatively unexplored.


    To describe how physicians discuss advance directives with patients.


    Prospective study.


    Five outpatient primary care medicine practices in Durham, North Carolina, and Pittsburgh, Pennsylvania.


    56 attending internists and 56 of their established patients.

    Eligible patients were at least 65 years of age or had a serious medical illness.


    Two raters coded transcripts of audiotaped discussions about advance directives to document how physicians introduced the topic of advance directives, discussed scenarios and treatments, provided information, elicited patient values, and identified surrogate decision makers.


    Conversations about advance directives averaged 5.6 minutes ; physicians spoke for two thirds of this time.

    In 91% of cases, physicians discussed dire scenarios in which most patients would not want to be treated, and 48% asked patients about their preferences in reversible scenarios.

    Fifty-five percent of physicians discussed scenarios involving uncertainty, typically using vague language.

    Patients'values were rarely explored in detail

    In 88% of cases, physicians discussed surrogate decision making and documents to aid in advance care planning. (...)

    Mots-clés Pascal : Médecin, Soin santé primaire, Relation médecin malade, Communication orale, Médecine, Prospective, Homme, Progrès médical

    Mots-clés Pascal anglais : Physician, Primary health care, Physician patient relation, Oral communication, Medicine, Prospective, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0439917

    Code Inist : 002B30A05. Création : 25/01/1999.