The public's perspectives on advance directives: implications for state legislative and regulatory policy

Determine the prevalence of advance directives (ADs) in Maryland and identify the barriers and enablers to their adoption, in order to guide the formulation of state legislative policy.

Cross-sectional survey administered over the telephone to a representative age-stratified random sample of 1195 Maryland adults.

Approximately 34% (n=401) of Maryland adults reported having an AD. Older adults (65+ years) were more likely than younger adults (18-64 years) to have ADs (p<0.001); the proportional difference between those with and without ADs diminished as age increased. Two times as many Whites than Blacks reported having ADs (43-23%; p<0.001). Of those who had an AD, the primary motivations for creating one was a personal medical condition or a diagnosis to one's self or a family/friend (41%). Those without ADs identified lack of familiarity with them (27%), being too young or healthy to need one (14%), or uncertainty of the process for adopting one (11%) as reasons for not having one.

Barriers to AD adoption appear amenable to policy interventions. Policies that seek to increase access and ensure ease of enrollment, combined with a targeted public health advocacy campaign, may help increase the prevalence of ADs.