Measuring Individual Advance Directive Efficacy
Through Normative Analyses

Scoring Documents

Check box

A completed "Lifecare Advance Directive" (LAD), or a "Lifecare Discussion Guide" (LDG), or a "Lifecare Representative Directive" (LRD), provides a detailed profile of health care and treatment wishes in a variety of circumstances.  Previous research, involving nearly 1,000 participants, has revealed the most common response patterns to the identified content. While individual variation is to be expected, dramatic departures from common response patterns (i.e., one full statistical standard deviation or more) helps to identify individuals who are at high risk of extremely burdensome medical care.

Identifying these individuals is important, as people often make health care directives and treatment choices based upon numerous potential biases.  Historically, possible biases include: 
1.  A belief that "doing everything" means the"best" care. 
2. Fears about possible suffering and prolonged dying. 
3.  Concerns about having their life artificially "saved" into health conditions they never wanted to live with. 
4.  Anxiety about becoming a burden to others (either financially or physically). 

More recently, additional concerns are being seen: 
1.  Fear of being medically abandoned because of an advance directive that includes directions to withhold or withdraw treatment. 
2.  Worries about being prematurely allowed to die. 
3.  Concerns that life-sustaining treatment decisions will be driven by someone else's "quality of life" definition being imposed upon them . 
4.  Anxiety that insurance and/or medical rationing principles will be used to deprive them of high quality health care. 
4.  Concerns that personal religious or other pro-life "vitalist" views may be ignored.

Physicians, nurse educators, medical counselors, social workers and others must often try to sort through these potential biases.  In the past there was no way to readily identify individuals who were at high risk of pursuing graphically burdensome medical treatment in the face of extremely poor health outcomes. 

Now, however, health care professionals will be able to score a completed Lifecare directive in advance, and compare the individual's overall score against the existing normative values derived from prior research with the general public. Thus, the scoring process can identify those who are making choices that deviate significantly from the collective average.  In this way, those individuals placing themselves at highest risk can be identified early on. 


Doctor talking to patient

Upon identification, these individuals can be given additional information, or be prompted to attend an advance directive class, or they can be offered one-on-one counseling, etc.  Such education and counseling can often dispel inaccurate medical myths (i.e., that CPR is always effective, that high quality care means "doing everything", or that survivors of all graphic life-threatening conditions will invariably recover fully and without profound residual debilitation, etc).  In this way these individuals can become more fully informed and aware of what they actually requested, and the most likely consequences of their choices.

To assist with this, two carefully articulated, theory- and literature-grounded out- and inpatient pathways and programs can also be found in the Lifecare text, "Strengthening Advance Directives: overcoming past limitations through enhanced theory, design and application." For more information on this text and other products, click here.  To order this text, click here, and then locate and order the text in the "Professional Resources" section of the shopping cart. 

Writing

To download free scoring sheets, specific to the Lifecare advance directive document being used, click on the appropriate form as listed below -- by locale and/or document type. LAD refers to the Lifecare Advance Directive, and LRD refers to the Lifecare Representative Directive.  All are in PDF format.  If Adobe Reader is needed to open and read PDF files, click here for a FREE software download.

Lifecare "Scoring" Templates:

*LAD = "Lifecare Advance Directive"; LRD = Lifecare Representative Directive"

  Hands typing

By State: 
Alabama --
LAD Score Form; LRD Score Form
   Alaska -- LAD Score Form; LRD Score Form
   Arizona -- LAD Score Form; LRD Score Form
   Arkansas -- LAD Score Form; LRD Score Form
   California -- LAD Score Form; LRD Score Form
   Colorado -- LAD Score Form; LRD Score Form
   Connecticut -- LAD Score Form; LRD Score Form
   Delaware -- LAD Score Form; LRD Score Form
   District of Columbia -- LAD Score Form; LRD Score Form
   Florida -- LAD Score Form; LRD Score Form
   Georgia -- LAD Score Form; LRD Score Form
   Hawaii -- LAD Score Form; LRD Score Form
   Idaho -- LAD Score Form; LRD Score Form
   Illinois -- LAD Score Form; LRD Score Form
   Indiana -- LAD Score Form; LRD Score Form
   Iowa -- LAD Score Form; LRD Score Form
   Kansas -- LAD Score Form; LRD Score Form
   Kentucky -- LAD Score Form; LRD Score Form
   Louisiana -- LAD Score Form; LRD Score Form
   Maine -- LAD Score Form; LRD Score Form
   Maryland -- LAD Score Form; LRD Score Form
   Massachusetts -- LAD Score Form; LRD Score Form
   Michigan -- LAD Score Form; LRD Score Form
   Minnesota -- LAD Score Form; LRD Score Form
   Mississippi -- LAD Score Form; LRD Score Form
   Missouri -- LAD Score Form; LRD Score Form
   Montana -- LAD Score Form; LRD Score Form
   Nebraska -- LAD Score Form; LRD Score Form
   Nevada -- LAD Score Form; LRD Score Form
   New Hampshire -- LAD Score Form; LRD Score Form
   New Jersey -- LAD Score Form; LRD Score Form
   New Mexico -- LAD Score Form; LRD Score Form
   New York -- LAD Score Form; LRD Score Form
   North Carolina -- LAD Score Form; LRD Score Form
   North Dakota -- LAD Score Form; LRD Score Form
   Ohio -- LAD Score Form; LRD Score Form
   Oklahoma -- LAD Score Form; LRD Score Form
   Oregon -- LAD Score Form; LRD Score Form
   Pennsylvania -- LAD Score Form; LRD Score Form
   Rhode Island -- LAD Score Form; LRD Score Form
   South Carolina -- LAD Score Form; LRD Score Form
   South Dakota -- LAD Score Form; LRD Score Form
   Tennessee -- LAD Score Form; LRD Score Form
   Texas -- LAD Score Form; LRD Score Form
   Utah -- LAD Score Form; LRD Score Form
   Vermont -- LAD Score Form; LRD Score Form
   Virginia -- LAD Score Form; LRD Score Form
   Washington State -- LAD Score Form; LRD Score Form
   West Virginia -- LAD Score Form; LRD Score Form
   Wisconsin -- LAD Score Form; LRD Score Form
   Wyoming -- LAD Score Form; LRD Score Form

BY TERRITORY: 
American Samoa --
LAD Score Form; LRD Score Form
   Guam -- LAD Score Form; LRD Score Form
   Puerto Rico -- LAD Score Form; LRD Score Form
   Virgin Islands -- LAD Score Form; LRD Score Form

BY MILITARY BRANCH (active duty or VA facility residents only)
Air Force -- Air Force Score Form
Army -- Army Score Form
Coast Guard -- Coast Guard Score Form
Marines -- Marines Score Form
Navy -- Navy Score Form
Veteran's Facility -- VET'S LAD Score Form; VET'S LRD Score Form

BY INTERNATIONAL LOCALE: 
Generic International Fomat -- LAD Score Form; LRD Score Form

BY FEDERAL FACILITY STATUS
Federal Inmate Directive Format -- LAD Score Form; LRD Score Form

BY DOCUMENT TYPE: 
The Discussion Guide (non-binding directive) -- LDG Score Form


Copyright LifecareDirectives, LLC 1995-2009