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OBJECTIVE: To evaluate whether the lack of effect of advance directives (ADs) on decision‐making in SUPPORT might arise, in part, from the content of the actual documents.

DESIGN: Advance directives placed in the medical records were abstracted for date of completion and content of additional written instructions. We examined directives with instructions to forgo life‐sustaining treatment in the current state of health to determine whether care given was consistent with preferences noted in those directives.

SETTINGS: Five teaching hospitals in the United States.

PATIENTS: A total of 4804 patients with at least one of nine serious illnesses were admitted to five teaching hospitals in the 2 years following implementation of the Patient Self‐Determination Act. Patients were part of a randomized controlled trial to improve decision‐making and outcomes.

RESULTS: From the medical records of 4804 patients, a total of …