The Institute of Medicine's report, “Approaching
Death: Improving Care at the End of Life,”
the American Medical Association's “Education
for Physicians on End-of-Life Care” project, the
Open Society Institute's “Project on Death in
America,” and the “Last Acts” initiative
sponsored by the Robert Wood Johnson Foundation have focused
attention on improving the care of dying patients. These
efforts include advance care planning and the use of written
advance directives (ADs). Although previous studies have
provided quantitative descriptions of patient preferences
for life-sustaining treatment, including those documented
in written ADs, to our knowledge open-ended written
preferences have not been studied. Studies of these
open-ended preferences could highlight issues with respect
to quality end-of-life care. The purpose of this study
was to explore the open-ended proxy, health, and personal
care preferences of people with HIV as expressed in a written
AD form.