ENHANCEMENT OF PROXY APPOINTMENT FOR OLDER PERSONS - PHYSICIAN COUNSELING IN THE AMBULATORY SETTING

OBJECTIVE: To determine the effectiveness of physician-initiated couns elling on the rate of health care proxy appointment. DESIGN: Observati onal study of an intervention in a convenience sample. SETTING: A geri atric outpatient clinic in a tertiary care teaching hospital, New York , New York PARTICIPANTS: A total of 687 patients enrolled in the geria tric clinic during the study period March 1991 through g-e June 1993. INTERVENTION: Physician counselling about the New York State Health Ca re Proxy Law, distribution of educational materials and healthcare pro xy forms, and reminders in 331 of 466 eligible patients. MEASUREMENTS: Rate of healthcare proxy appointment in eligible and counselled group s; predictors of appointment and non-appointment; time elapsed from co unselling to appointment; reasons for non-appointment; characteristics of the proxy appointment process. RESULTS: A healthcare proxy was app ointed for 31.5% of patients eligible for counselling and for 44% of p atients who actually received the intervention, compared with a 2.3% p roxy appointment rate at baseline. Eighty-one percent of the patients completing the proxy appointment process did so at or before their thi rd clinic return visit after the counselling intervention. Of the coun selled patients who did not appoint a proxy, 25% explicitly declined, and 75% had not come to a decision by the end of the study period. Pro xy completion was associated with ethnicity, education, and more frequ ent clinic visits. Of those who appointed a proxy, 97% had good or fai r comprehension of the procedure, 92% discussed the appointment with t heir designees, 63% appointed a daughter or son, and 80% discussed the ir wishes for care at the end of life with their proxy. CONCLUSIONS: P hysician counselling of older outpatients is an effective means of inc reasing healthcare proxy appointments.