Increasing the use of advance directives in medical outpatients

ObjectiveWe studied whether a simple educational intervention would increase patient completion of advance directives and discussions on end-of-life issues.DesignRandomized, controlled trial.SettingOutpatient clinic of a teaching hospital.SubjectsOne hundred eighty-seven outpatients of a primary care internal medicine clinic.InterventionStudy 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 resultsCompletion 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.ConclusionsInteractive group seminars for medical outpatients increased discussions and use of written advance directives.