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OBJECTIVES: To examine the role of advance directives (ADs) 10 years after the Patient Self‐Determination Act.

DESIGN: Mortality follow‐back survey.

SETTING: People who died in a nursing home, hospital, or at home.

PARTICIPANTS: Bereaved family member or other knowledgeable informant.

MEASUREMENTS: Telephone interviewers that asked about the use of written ADs, use of life‐sustaining treatment, and quality of care by asking whether staff provided desired symptom relief, treated the dying with respect, supported shared decision‐making, coordinated care, and provided family with the needed information and emotional support.

RESULTS: Of the 1,587 people who died, 70.8% had an AD. Persons who died at home with hospice or in a nursing home were more likely to have an AD. In addition, those with an AD were less likely to have a feeding tube (17% vs 27%) or use a respirator in the last …