Spring 2014

Muddled Directives

Confusion among patients and health-care proxies is widespread

Family members who sign “do-not-hospitalize” orders on behalf of older relatives likely to be moved from a nursing home to a hospital are frequently unclear about what they are asking, according to a recent article in the New York Times. Working together with colleagues in Pennsylvania and Ohio, Assistant Professor Sarah Goff, a specialist in internal medicine at the Tufts-affiliated Baystate Medical Center, served as co-author of the small study of 16 health-care proxies for patients with advanced dementia.

The study found that proxies are often confused about how “do-not-hospitalize” orders work. Some proxies believed, mistakenly, that the directives meant medical intervention of any sort would be withheld from the patient.

“Do-not-hospitalize” directives come in two main flavors. The first prohibits a patient from being sent to a hospital under any circumstances.

The second directive is a more general recommendation to avoid the hospital, but with stipulations that an admission may make sense and be approved for the patient under certain conditions.

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