Promoting the Use of Advance DirectivesAn Empirical Study
Kimber P. Richter, MA;
Sondra Langel;
Stephen B. Fawcett, PhD;
Adrienne Paine-Andrews, PhD;
Lucia Biehler, RN;
Robert Manning, MD
Arch Fam Med. 1995;4(7):609-615.
Abstract
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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.
Author Affiliations
From the Department of Human Development, University of Kansas, Lawrence (Drs Fawcett and Paine-Andrews and Ms Richter); Kansas Health Ethics, Wichita (Ms Langel); and the Wichita Medical Practice Association (Ms Biehler) and the Department of Internal Medicine (Dr Manning), University of Kansas School of Medicine^Wichita.
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