Motivational approaches need to prompt AD
Getting patients to complete advance directives requires more than educational materials, states a recent study. Instead, end-of-life workers need to work toward developing more motivational approaches to convince older Americans to plan how they die.
Although the goal of educational materials is to prompt the completion of advance directives, providing a knowledge base for informed decision making is also of value, researchers concluded. They added that future effort will require the addition of other educational or motivational approaches in order to increase advance care planning. The results of the study, "A Multimedia Intervention on Cardiopulmonary Resuscitation and Advance Directives," was published in December issue of the Journal of General Internal Medicine.
Study conducted at VA medical center
The study was conducted in the waiting rooms of a medical outpatient clinic at a university-affiliated Veterans Affairs medical center. Selected patients were given educational intervention about life-sustaining treatments, cardiopulmonary resuscitation and its outcomes, and advance directives.
The patients, all veterans over 70 years of age, were randomized into two groups. The control group of 55 patients received a written handout that described advance directives and how to make one, but did not specifically address CPR or the outcomes of CPR. The experimental group of 62 patients received the same handout, as well as another about CPR and its outcomes, and viewed a 10-minute videotape about advance directives.
Subjects completed questionnaires
All patients in both groups completed a pre-intervention questionnaire, received the control or experimental intervention, saw their medical care provider (physician, physician assistant, or internal medicine resident), and completed a post-intervention questionnaire. A follow-up questionnaire was mailed to all participants two to four weeks following their entry into the study. The response rates for the questionnaires were 98% (pre-intervention), 92% (post-intervention), and 77% (two-to four-week follow-up).
Prior to the intervention, two-thirds of respondents knew what CPR was, a quarter knew what an advance directive was, one-third correctly estimated their likelihood of being resuscitated and discharged home, and approximately two-thirds wanted to inform their physicians of their preference regarding CPR.
The post-intervention questionnaire consisted of the same questions, as well as questions of whether CPR or advance directives were discussed during the clinic visit; whether patients wished to discuss the issue with their family; and whether the information was helpful.
The experimental group did score higher on knowledge of CPR and advance directives in this questionnaire. However, although more than half of the patients wanted to discuss advance care planning with their physicians, few patients did so at that visit.
The follow-up questionnaire repeated the above questions plus asked whether CPR or advance directives were discussed with the family and whether the patients had begun to prepare an advance directive. For the most part, any differences between the two groups lessened or disappeared in this two- to four-week follow-up. One sixth of all participants reported they had begun to prepare an advance directive.
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