Researchers from the Oregon Health Sciences University report that stress levels are extremely high for family members who must decide whether or not life support should be withdrawn from relatives too incapacitated to decide for themselves. Stress was least severe when patients’ written advance directives were available and most severe in the absence of an advance directive.

Unfortunately, only about 20% of adults have advance directives, according to National Institute of Nursing Research (NINR) Director Patricia A. Grady, PhD, RN. "We must find strategies to significantly increase their use to diminish stress for both patients and families going through life’s final phase."

The study focused on 74 family members of patients who had recently died in hospitals. Family members were interviewed twice—at one to two months after the death and again at six to nine months after. The findings revealed that in the absence of an advance directive, families were more likely to push for prolonging the patient’s life, even when treatments were not working and the patient was suffering. When the patient had executed an advance directive, the family members were more comfortable focusing on the patient’s quality of life.