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April 24, 1996

The SUPPORT Project and Improving Care for Seriously III Patients-Reply

Author Affiliations

University of Virginia Charlottesville
Duke University Medical Center Durham, NC
George Washington University Medical Center Washington, DC
MetroHealth Medical Center Cleveland, Ohio
Marshfield Medical Research Foundation/ St Joseph's Hospital Marshfield, Wis
Beth Israel Hospital Boston, Mass
University of California at Los Angeles Medical Center

JAMA. 1996;275(16):1230-1231. doi:10.1001/jama.1996.03530400015026

In Reply.  —The encouraging experiences reported by Dr Frank and Ms Campbell helped shape the SUPPORT intervention. Our different findings may result from our randomized trial design, our retaining established physician-patient relationships, or our more rigorous evaluation design.We welcome the opportunity to respond to Dr Dougherty and clarify a major public misinterpretation of SUPPORT's findings—that physicians were ignoring patients' wishes. SUPPORT demonstrated a failure of communication between clinicians and patients, not a failure of physicians to listen to patients. This is also a response to Dr Donnelly's suggestion that the SUPPORT intervention should have been more prescriptive. We designed the intervention to be as forceful as possible given the evaluation design of the study and the concerns of the institutional review boards that all care be under the control of the attending clinician.We agree with Dr Godec that, as part of any comprehensive approach to this problem, financial