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BACKGROUND: Discussions of end‐of‐life care should be held prior to acute, disabling events. Many barriers to having such discussions during primary care exist. These barriers include time constraints, communication difficulties, and perhaps physicians' anxiety that patients might react negatively to such discussions.

OBJECTIVE: To assess the impact of discussions of advance directives on patients' satisfaction with their primary care physicians and outpatient visits.

DESIGN: Prospective cohort study of patients enrolled in a randomized, controlled trial of the use of computers to remind primary care physicians to discuss advance directives with their elderly, chronically ill patients.

SETTING: Academic primary care general internal medicine practice affiliated with an urban teaching hospital.

PARTICIPANTS: Six hundred eighty‐six patients who were at least 75 years old, or at least 50 years old with serious …