The completion of advance directives in primary care

The purpose of this study was to determine whether discussion about and distribution of advance directive forms in a rural, private primary health care office would increase the number of patients who complete and return advance directive forms. This study was also designed to identify individual characteristics of patients who complete advance directives compared with those who do not.

The sample consisted of 195 patients who ranged in age from 21 to 88 years and visited the primary care office during a 1-month period. Patients who met the inclusion criteria were asked to complete a brief questionnaire while waiting to see their primary care provider, either a physician or a nurse practitioner. The survey included questions about education, previous experience with illness, religion, contact with family members, and attitudes concerning death. The primary care provider then briefly discussed with each patient the advance directive and provided an advance directive form to be completed and returned. The form was short and easy to complete.

The discussion about and distribution of advance directive forms in the primary care office results in a 45% return rate. Older patient age (P=.001), longer length of time in the practice (P=.039), less education (P=.025), and physician provider (gamma=.002) were associated with higher completion rates. The variables of provider and level of education were also influenced by older age.

Discussion about and distribution of advance directive forms should be incorporated into primary office care for all adults.