Systematic review of educational interventions for improving advance directive completion

Area of Science:

• Health Services Research
• Medical Education
• Gerontology

Background:

• Advance directives (ADs) are crucial for patient autonomy in healthcare.
• Understanding the effectiveness of educational interventions in promoting AD completion is vital for improving patient care and outcomes.

Purpose of the Study:

• To systematically review and analyze evidence on the effectiveness of educational interventions in increasing the completion of advance directives (ADs).
• To compare the efficacy of different types of educational interventions against control groups and against each other.

Main Methods:

• A systematic literature review adhering to Cochrane review criteria was conducted.
• Twelve randomized and four nonrandomized studies published between 1991 and 2009 were analyzed.
• The primary outcome measure was the percentage of newly completed ADs, calculated based on baseline and follow-up data.

Main Results:

• Evidence regarding the effectiveness of educational interventions versus controls was inconsistent.
• Combined written and verbal educational interventions demonstrated greater efficacy than single written interventions for increasing AD completion in adult outpatients and hospitalized elderly patients.

Conclusions:

• While calculating the percentage of newly completed ADs facilitated comparisons, the overall evidence base for educational interventions is weak.
• Further randomized controlled trials with diverse samples are recommended before conducting more comparative intervention studies.