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Advance Directives: Do They Provide Direction?

Joel M. Zinberg, MD, JD
JAMA. 1990;263(13):1764. doi:10.1001/jama.1990.03440130044014.
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To the Editor.—  The study by Davidson et al1 purports to be "the first attempt to evaluate physicians' attitudes and experiences with advance directives." I published such an empirical study in the Vermont Law Review more than 6 months ago2; my results were substantially different.Determining physicians' experiences and attitudes is important. Physicians substantially control the implementation of directives. However, a mailed questionnaire is not the optimal way to elicit information about whether or how directives have changed the care patients received. A questionnaire lends itself to wide distribution and creates the illusion of statistical precision. However, it often suggests rather than elicits answers and misses the nuances of the responses. (Notice, for example, the three aberrant responses discussed on pages 2418 and 2419 in the article by Davidson et al.)Davidson et al mailed questionnaires to 1293 physicians. Eighty-two physicians were excluded and 790 responded (65.2%).


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