This study shows that having an advance directive is extremely important for those in nursing facilities. Especially for dialysis patients, an advance directive will enhance end of life care based on the patient’s preferences and values. Those with an advance directive explained when they wanted to stop dialysis or reject invasive surgeries. Without these instructions patients are routinely treated and go put through medical procedures without their say because it is not specified. Advance directives are the best way that your wishes can be explained in end of life care.