Promoting the use of advance directives. An empirical study
K. P. Richter, S. Langel, S. B. Fawcett, A. Paine-Andrews, L. Biehler and R. Manning
Department of Human Development, University of Kansas, Lawrence, USA.
OBJECTIVE: To examine the effects of a practical method to increase patient
completion and filing of advance directives. METHODS: Randomized controlled
trial to examine the effects of structured discussions, information, and
mailed reminders on completion of advance directives by internal medicine
outpatients. MAIN OUTCOME MEASURE: Presence of advance directives in
patients' medical files. Secondary analyses include (1) participant
satisfaction with procedures, (2) data on delayed effects of discussion,
and (3) data on discrepancies in patients' completion of forms. RESULTS:
Six months following the intervention, 23% of patients in the experimental
group and 3% of patients in the control group had directives on file. The
findings were statistically significant. Patients, nurses, and physicians
were satisfied with intervention procedures. Chart reviews at 6 weeks and 6
months indicated that intervention effects were delayed. CONCLUSIONS:
Structured discussions and follow-up mailings substantially increased use
of advance directives and were time effective and cost-effective.
