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Increasing the use of advance directives in medical outpatients
F J Landry1, K Kroenke, C Lucas
1Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md., USA.
Objective:
We studied whether a simple educational intervention would increase patient completion of advance directives and discussions on end-of-life issues.
Design:
Randomized, controlled trial.
Setting:
Outpatient clinic of a teaching hospital.
Subjects:
One hundred eighty-seven outpatients of a primary care internal medicine clinic.
Intervention:
Study subjects attended a 1-hour interactive seminar and received an informational pamphlet and advance directive forms. Control subjects received by mail the pamphlet and forms only.
Measurements And Main Results:
Completion of the advance directive was the main measurement. There were no significant differences in baseline characteristics of either group. Follow-up at 1 month revealed advance directive completion in 38% of study versus 24% of control subjects (p = .04), and discussions on advance planning in 73% of study versus 57% of control subjects (p = .02). Patients most likely to complete the documents were white, married, or attendees at the educational seminar.
Conclusions:
Interactive group seminars for medical outpatients increased discussions and use of written advance directives.