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The SUPPORT Project and Improving Care for Seriously III Patients-Reply

William A. Knaus, MD; Frank Harrell, PhD; Robert Califf, MD; Joanne Lynn, MD; Alfred Connors, MD; Norman Desbiens, MD; Russell S. Phillips, MD; Robert Oye, MD
JAMA. 1996;275(16):1230-1231. doi:10.1001/jama.1996.03530400015026.
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In Reply.  —The encouraging experiences reported by Dr Frank and Ms Campbell helped shape the SUPPORT intervention. Our different findings may result from our randomized trial design, our retaining established physician-patient relationships, or our more rigorous evaluation design.We welcome the opportunity to respond to Dr Dougherty and clarify a major public misinterpretation of SUPPORT's findings—that physicians were ignoring patients' wishes. SUPPORT demonstrated a failure of communication between clinicians and patients, not a failure of physicians to listen to patients. This is also a response to Dr Donnelly's suggestion that the SUPPORT intervention should have been more prescriptive. We designed the intervention to be as forceful as possible given the evaluation design of the study and the concerns of the institutional review boards that all care be under the control of the attending clinician.We agree with Dr Godec that, as part of any comprehensive approach to this problem, financial


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