Study objectives: The study assessed the interests of
ambulatory cardiac patients in advance planning and their
willingness to participate in rehabilitation program-based end-of-life
education. Design: Observational survey study.
Setting: Fourteen outpatient cardiac rehabilitation
programs in 11 states.
Participants: Four hundred
fifteen subjects enrolled in cardiac rehabilitation.
Measurements and results: A questionnaire determined
patient preferences for advance planning, completion of advance
directives, completion of patient-physician discussions on end-of-life
care, and effects of health status on patient acceptance of
life-sustaining interventions. Seventy-two percent of patients wanted
to direct their own end-of-life care, 86% desired more information on
advance directives, 62% wanted to learn about life-sustaining care,
and 96% were receptive to advance-planning discussions with their
physicians. Seventy-two percent of patients had considered that they
might require life-sustaining care in the future; acceptability of
resuscitative care depended on health status and probability of
survival. However, only 15% had discussed advance planning with their
physicians, and 10% were confident that their physicians understood
their end-of-life wishes. Physicians and cardiovascular rehabilitation
programs were considered desirable sources of information on advance
Conclusions: Cardiac patients enrolled in
rehabilitation programs want to learn more about end-of-life care and
need more opportunities to discuss advance planning with their
physicians. Patients consider cardiovascular rehabilitation programs to
be acceptable sites for advance planning education.