An exploratory study of the use of advance directives by US oncologists

Purpose: This study sought to determine the rate of advance directive completion among US oncologists and factors influencing such a decision. Methods: We surveyed 7590 members of the American Society of Clinical Oncology using a webbased questionnaire. Results: The response rate was 8.1%. Most respondents (59%) had completed at least 1 document: 9% living will, 9% power of attorney for health care, and 41% both. Respondents who were older, men, married, with children, working in the community setting, radiation oncologists, and practicing general oncology were more likely than their counterparts to have an advance directive. Among those who had one, 95% and 36% had discussed their wishes with their loved ones and health care providers, respectively. Factors including experience at work, spouse, children, family, and religion had the most influence on respondents' decision. The majority of those without an advance directive reported either no reason or lack of time. Those who had them were more likely to report having a comprehensive review of their wishes with those closest to them, being more knowledgeable, having more routine discussions with their patients, and being more comfortable helping their patients complete one. Conclusion: Only about half of US oncologists who responded to our survey have completed an advance directive.