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Pennsylvania Patient Safety Authority Releases December Advisory
Date:1/12/2009

e definitions of a living will and other advance directives must be clearly understood for a patient's wishes to be accurately conveyed," Clarke said. Further, a DNR order is much different than a living will. They are not interchangeable.

"Each has its own meaning and circumstance in order to be carried out by the healthcare provider," Clarke added. "The issues surrounding both are not being understood clearly by patients, family members or healthcare providers according to the data we received."

Clarke cited recent studies that show the issue is not just in Pennsylvania. In a survey to determine the level of understanding of a living will among doctors, patients and their families the results show 71% of patients, 42% of family members and 27% of physicians did not understand when a living will becomes effective. Another study showed that patients with living wills poorly understood the meaning of "life-sustaining therapies" and the implications of other advance directives. Of 755 patients admitted to a community teaching hospital during the study period, 264 study participants were surveyed regarding their understanding of CPR. Of these, 82 (31%) had living wills. Most (76%) created their living will with a lawyer or family member; only seven percent involved a physician. After the patients were provided an explanation of the meaning of CPR, 37% of patients with living wills indicated they actually did not want CPR. Their living wills did not accurately reflect their treatment preferences.

The Authority suggests key elements needed for healthcare providers to implement to a successful advance directive program and that may be applied to the process of obtaining a DNR order. The Authority also offers tips for consumers to ensure they are educating themselves and their families about their exact preferences for end-of-life care.

For more information on living wills, DNR orders and Pennsylvania law
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SOURCE Pennsylvania Patient Safety Authority
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