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Default Options In Advance Directives Influence How Patients Set Goals For End-Of-Life Care

Loewenstein et al (2013)
George Loewenstein,Scott Halpern,Elizabeth Cooney,Kevin Volpp
Summary by 
Mark Egan

Examines defaults in a healthcare context, by randomly assigning 132 seriously ill patients to complete one of three types of advance directive. Two types had end-of-life care options already checked – the defaults – but Group 1 favored comfort-oriented care and Group 2 favored life-extending care. Group 3 was a standard advance directive with no options checked. The authors found that while most patients wanted comfort-oriented care, the defaults influenced those choices. Group 1 (comfort-oriented) - 77% of patients in the comfort-oriented group kept that choice.Group 2 (life-extending) - 43% of patients in the life-extending group rejected the default and selected comfort-oriented care instead.Group 3 (no default) – 61% of patients selected comfort-oriented care.The authors findings suggest that patients may not hold deep-seated preferences regarding end-of-life care.

A randomized evaluation found that presenting patients with a default, preselected influenced the type of end-of-life care patients chose. When the advance directed had no preselected option, 61% percent of patients chose comfort-oriented care.