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Developing a parsimonious model for predicting completion of advance directives.

Mary Judy Campbell¹, M Jo Edwards, Karen S Ward

¹Middle Tennessee State University, School of Nursing, Murfreesboro, TN 37132, USA. jcampbel@mtsu.edu

Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing

|May 31, 2007

Summary

Nurses can promote advance directive (AD) completion by providing AD information and fostering positive attitudes. Higher health literacy, however, was linked to reduced AD completion likelihood in older adults.

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Area of Science:

Gerontology
Health Education
Nursing Research

Background:

Advance directives (ADs) are crucial for patient autonomy in end-of-life care.
Understanding factors influencing AD completion is vital for healthcare providers, especially nurses.
Limited research exists on theory-based models for promoting AD self-determination.

Purpose of the Study:

To develop a theory-based model to guide nurses in promoting self-determination for advance directive (AD) completion.
Identify key factors influencing older adults' decisions to complete ADs.

Main Methods:

Descriptive study with 118 community-dwelling older adults in Tennessee, USA.
Multinomial logistic regression analysis to assess 15 factors influencing AD completion.
Statistical modeling to determine significant predictors of AD completion.

Main Results:

A parsimonious model identified three significant factors: receiving AD information, positive attitude index, and health literacy score.
Positive attitudes and receiving AD information increased the likelihood of AD completion.
Increased health literacy was paradoxically associated with a reduced likelihood of AD completion, explaining 25% of the variance.

Conclusions:

Only AD information, positive attitudes, and health literacy significantly impacted AD completion likelihood.
The findings suggest a need for further research into this model and effective nursing interventions for end-of-life decision-making support.
Nurses play a key role in facilitating informed patient choices regarding advance directives.