All the talk was, of course, inspired by the painful saga of Terri Schiavo, the severely incapacitated Florida woman who died March 31, 2005, after a years-long family struggle over her care. At the time, much was made of the fact that the young woman did not leave written instructions — a living will — about her own preferences.

The talk, apparently, did inspire some action: Since then, nearly 2 million people have downloaded forms for advance directives (living wills and other documents that spell out treatment preferences and designate decision-makers) from www.caringinfo.org, a website set up by the National Hospice and Palliative Care Organization; another 50,000 have asked for the forms after calling the group's support line (800-658-8898).

Other organizations report a similar spike in end-of-life and crisis-care planning.

Problem solved?

No, experts say. For one thing, many people still have not completed basic first steps.

"I fear a lot of people are just downloading these papers and then just letting them sit on their desks," says J. Donald Schumacher, president and chief executive of the hospice group.

Others, he says, fill out the paperwork, but then don't share copies — and have vital conversations about them — with family members and physicians.

A study in December by the Pew Research Center found that 29% of adults had living wills, up from 12% in 1990. Rates were highest among the oldest adults: 57% of those ages 78 to 92 had living wills.

But recent research suggests that even people who have taken these steps might not have their wishes followed in a crisis.

When faced with hypothetical situations — such as having a loved one in a coma with doctors predicting no chance of recovery — surrogate decision-makers (spouses, children and others) make different treatment choices from those of the role-playing patient about one-third of the time, according to a study published in March in the Annals of Internal Medicine.

And, strikingly, people who discussed such questions in advance were no more likely to agree in the hypothetical crisis, researchers from the National Institutes of Health say.

The findings did not surprise Peter Ditto, a psychologist at the University of California-Irvine.

"Predicting what someone else wants is difficult," he says, for many reasons.

One is that people change their minds: In Ditto's studies, 30% of people change choices when presented with the same medical scenarios a year apart.

Another problem, he says, is that people can't predict the exact nature of the crisis.

"You can never match the creativity of nature," he says.

But planning remains important. The key, most experts say, is to:

• Keep talking with family members and health care providers.

• Update documents as needed (an annual review is a good idea).

• Accept that others, who might have more information about exact circumstances, might choose differently from what you think you would.

Studies show that "people are pretty comfortable with that," Ditto says. "They don't want to micromanage their deaths. ... But they do want to have a sense of control; they do want their values heard."

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