Will outpatients complete living wills? A comparison of two interventions

To test the efficacy of two intervention methods that aimed to increase the percentage of adult clinic patients who completed living wills and placed them on file with their physicians within a four-month period.

There were one control and two intervention groups. Surveys were separated by age and gender categories and randomly selected for the final sample.

The internal medicine outpatient clinic of a large tertiary hospital.

All patients who visited the clinic were asked whether they would be willing to fill out a survey. The final sample included 167 adult patients who comprised three study groups.

The first intervention relied solely on a booklet that described the Minnesota Living Will Act, general information concerning advance directives, and medical interventions that could be considered extraordinary if used for a patient in a terminal condition. The second intervention relied on both the booklet and repeated physician-initiated discussions with the patient about the probable value of a living will.

The booklet/physician intervention was found to be significantly more effective than either the booklet-only intervention or no intervention (p less than 0.05 and 0.01, respectively).

The physician intervention used in this population could be undertaken in any primary care clinic. Time spent in discussion before a crisis may be significantly shorter and qualitatively better than time spent in discussion with families who must make decisions during a crisis.