Advance directives: barriers to completion.

The concept of advance directives, although sound in theory, appears to be failing to meet the needs of many patients. Advance directives have been endorsed by both the healthcare profession and the general public, yet few individuals have documented their wishes for treatment preferences in end-of-life decisions. A review of 15 research articles revealed three main barriers to the completion and effective use of advance directives. These barriers are: (a) lack of education or knowledge regarding advance directives, (b) difficulties with paperwork completion, and (c) discordance between patient, family members or proxy, and provider. Future research is suggested to generate information that will facilitate meeting the needs of patients and their families in this most difficult aspect of healthcare delivery.