Article

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

Health Affairs (Impact Factor: 4.97). 02/2013; 32(2):408-17. DOI: 10.1377/hlthaff.2012.0895
Source: PubMed

ABSTRACT

Although decisions regarding end-of-life care are personal and important, they may be influenced by the ways in which options are presented. To test this hypothesis, we randomly assigned 132 seriously ill patients to complete one of three types of advance directives. Two types had end-of-life care options already checked-a default choice-but one of these favored comfort-oriented care, and the other, life-extending care. The third type was a standard advance directive with no options checked. We found that most patients preferred comfort-oriented care, but the defaults influenced those choices. For example, 77 percent of patients in the comfort-oriented group retained that choice, while 43 percent of those in the life-extending group rejected the default choice and selected comfort-oriented care instead. Among the standard advance directive group, 61 percent of patients selected comfort-oriented care. Our findings suggest that patients may not hold deep-seated preferences regarding end-of-life care. The findings provide motivation for future research examining whether using default options in advance directives may improve important outcomes, including patients' receipt of wanted and unwanted services, resource use, survival, and quality of life.

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Available from: Michael Harhay
    • "Research has shown that in many situations people accept the default. This effect is present in both minor decisions such as online privacy settings (Johnson, Bellman, & Lohse, 2002) and more important decisions concerning pension savings (Thaler & Benartzi, 2004), end-of-life care (Halpern et al., 2013), and organ donation (Johnson & Goldstein, 2003). The effect of defaults on behavior is caused by a number of different processes, including effort reduction, implied endorsement, and the unwillingness to give up the status quo when it is understood as an endowment (Dinner et al., 2011; McKenzie et al., 2006). "
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    ABSTRACT: Defaults have been shown in prior research to impact important decisions, including how people complete advance directives (which specify the medical treatments they want to receive if they become unable to communicate their wishes). However, defaults and other nudges are often criticized for violating individual autonomy because those affected are typically unaware that they are being influenced. We report results from a study in which people were informed that they were being defaulted, either before they completed a hypothetical advance directive or immediately afterwards (and then were given an opportunity to revise their choices). Neither pre-informing nor post-informing respondents appreciably diminished the impact of the defaults.
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