Background: Patients are encouraged to complete limitation-of-medical-treatment forms (LMTFs), sometimes referred to as code status forms or do-not-resuscitate forms, before admission to hospitals or other health care facilities in the United States. Objective: The purpose of this study was to review, evaluate, and to assess the LMTFs currently used in emergency medicine residency training programs throughout the United States. Methods: In February 2009, researchers sent letters to all allopathic and osteopathic emergency medicine residency program directors (n = 193) requesting a copy of the LMTF used in their hospital. These forms were evaluated for content, consistency, and readability. Results: Sixty-five responses were received (corrected response rate = 34%); 45 LMTFs were reviewed. Nineteen LMTFs required the signature of the patient, or the patient's appointed durable power of attorney for health care. The readability ranged from 11th to 17th grade (mean ± SD = 13.16 ± 1.77), greatly exceeding the average Americans' 8th-grade reading level. Conclusions: Our findings demonstrate that there is no standardization across LMTFs currently used in hospitals throughout the United States, and these forms are written above the literacy level of the average American adult. Therefore, there is a need to develop and disseminate an LMTF that is both consistent and better understood by the average American adult.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The do-not-resuscitate order: associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act.J Med Ethics. 2008; 34: 642-647
- Practical guidelines for do-not-resuscitate orders.Am Fam Physician. 1994; 50 (1303–4): 1293-1299
- Views of elderly patients and their relatives on cardiopulmonary resuscitation.BMJ. 1994; 308: 1677-1678
- End-of-life content in treatment guidelines for life-limiting diseases.J Palliat Med. 2004; 7: 754-773
- Accessed April 4, 2009)
- DO-Online.http://opportunities.osteopathic.org/search/search_results.cfm?CFID=885901&CFTOKEN=60fa8430694ed9cf-DE557976-92DB-C691-DA5BB8C034040730&jsessionid=f03064efe7772a2d34c44f123b2643554c32(Accessed April 4, 2009)
- Teaching patients with low literacy skills.JB Lippincott Company, Philadelphia1996
- Health literacy: a manual for clinicians.American Medical Association Foundation, Chicago2003
- SMOG grading: a new readability formula.J Reading. 1969; 12: 639-646
- How to test for readability: The SMOG readability formula: Harvard School of Public Health.Accessed April 1, 2009)
- Readability and patient education materials used for low-income populations.Clin Nurse Spec. 2009; 23: 33-40
- Readability assessment of internet-based consumer health information.Respir Care. 2008; 53: 1310-1315
- A comprehensive assessment of the difficulty level and cultural sensitivity of online cancer prevention resources for older minority men.Prev Chronic Dis. 2008; 5: A07
- Aging with dignity.Accessed April 4, 2009)
- An advance directive redesigned to meet the literacy level of most adults: a randomized trial.Patient Educ Couns. 2007; 69: 165-195
Published online: April 30, 2010
Accepted: February 18, 2010
Received in revised form: December 4, 2009
Received: September 29, 2009
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.