Empowerment of the older patient? A randomized, controlled trial to increase discussion and use of advance directives

J Am Geriatr Soc. 1992 Mar;40(3):269-73. doi: 10.1111/j.1532-5415.1992.tb02081.x.


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 reexamined 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 greater than 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Directives*
  • Aged
  • Aged, 80 and over
  • Chicago
  • Communication
  • Female
  • Hospitals, University
  • Humans
  • Information Dissemination*
  • Male
  • Medical Records / standards*
  • Middle Aged
  • Outpatient Clinics, Hospital
  • Patient Education as Topic / standards*
  • Patient Participation
  • Power, Psychological*