Interventions to promote the use of advance directives: an overview of systematic reviews

Patient Educ Couns. 2010 Jul;80(1):10-20. doi: 10.1016/j.pec.2009.09.027. Epub 2009 Oct 29.


Objective: To identify, appraise and synthesise the results of systematic reviews of the literature (SRLs) that examines the effectiveness of interventions to increase advance directive (AD) completion rate.

Methods: Narrative review of the literature-an overview of SRLs focused on interventions to improve patients' AD completion rate.

Results: Seven SRLs were located. A wide range of interventions was identified in order to determine their influence on the AD completion rate.

Conclusion: The most effective method of increasing the use of ADs is the combination of informative material and repeated conversations over clinical visits. The use of passive informative material in isolation does not significantly increase AD completion rates. However, when interactive informative interventions are employed, the AD completion rate increases and the majority of the studies identify multiple sessions as the most effective method for direct interaction between patients and health care professionals.

Practice implications: The progressive ageing of the population and the provision of quality care during the process of ageing and dying, have given rise to the Governments' interest in developing moral autonomy and regulating tools as ADs. In order to put legislation into practice it is necessary to set up successful interventions to expand ADs use.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Advance Directives*
  • Communication*
  • Humans
  • Information Dissemination
  • Patient Education as Topic
  • Patient Participation*
  • Professional Role*