EMPOWERMENT OF THE OLDER PATIENT - A RANDOMIZED, CONTROLLED TRIAL TO INCREASE DISCUSSION AND USE OF ADVANCE DIRECTIVES

Objective: To see if an educational intervention directed at older outpatients would lead to increased use or discussion of advance directives and to characterize patients' reasons for not obtaining advance directives. Design: Randomized, controlled trial of an educational intervention versus usual care. Setting: Outpatient geriatrics clinic of a university hospital. Patients: One hundred and thirty-one non-demented patients over the age of 65 who did not have an advance directive documented in their record at the start of the study. Forty-eight patients were in the trial arm and 83 in the control. Main Outcome Measures: All patients had their charts re-examined 6 months after enrollment to look for the presence of a living will, a durable power of attorney for health care, or a physician's note describing a discussion of advance directives. Trial patients were also re-interviewed to examine their reasons for not executing an advance directive. Main Results: Six months after the intervention, only seven of the 48 trial subjects (15%) had an advance directive or note describing discussion of advance directives in their charts compared to eight of the 83 controls (10%) (P > 0.05). When asked to give reasons for not obtaining an advance directive, many patients' responses pointed to procrastination as a significant barrier. Conclusions: Promoting advance directive use is a complicated task. Barriers other than information and access to documents appear to be involved and need to be addressed in future efforts.