The care span: Default options in advance directives influence how patients set goals for end-of-life care

Scott D. Halpern, George Loewenstein, Kevin G. Volpp, Elizabeth Cooney, Kelly Vranas, Caroline M. Quill, Mary S. McKenzie, Michael O. Harhay, Nicole B. Gabler, Tatiana Silva, Robert Arnold, Derek C. Angus, Cindy Bryce

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


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 endof- 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.

Original languageEnglish (US)
Pages (from-to)408-417
Number of pages10
JournalHealth Affairs
Issue number2
StatePublished - Feb 2013
Externally publishedYes

ASJC Scopus subject areas

  • Health Policy


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