IMPLEMENTATION OF THE PATIENT SELF-DETERMINATION ACT IN A HOSPITAL SETTING - AN INITIAL EVALUATION

Background: The Patient Self-Determination Act aims to enhance patient awareness of advance directives by requiring health-care institutions to ask patients whether they have advance directives and to inform pa tients of their rights to prepare these documents. We investigated the following: (1) compliance of the hospital staff with implementing thi s act, (2) the effects of this act on the extent to which patients dis cuss and prepare advance directives, and (3) variables that might infl uence patient discussions on advance planning and preparation of advan ce directives. Methods: We surveyed 219 patients from a university hos pital that implemented a nurse-dependent advance directive program. We also conducted a telephone interview with 57% of these patients at le ast 6 months after hospital discharge. Results: Nurses asked 70% of th e patients about the existence of an advance directive and of these pa tients, only 57% remembered the inquiry. Only 57% of the patients rece ived the brochure on advance directives and of these patients, only 55 % read the brochure. Only 2% of the patients requested to receive addi tional information on advance directives. Less than one quarter of the patients had discussions on advance planning while in the hospital an d of those patients who were contacted within 6 months after hospital discharge, 39% had discussions on advance planning and 15% prepared an advance directive. Race was an independent predictor for hospital dis cussions, and educational level was an independent predictor for discu ssions and preparation of advance directives after hospital discharge. Conclusion: To enhance the effectiveness of a nurse-dependent advance directive program, hospitals may need (1) to strengthen the quality o f the patient-nurse encounter in which the issue of advance directives is raised to more effectively promote patient interest, discussions, and preparation of advance directives and (2) to account for the socia l diversity of their patient population.