PROMOTING COMPLETION OF HEALTH-CARE PROXIES FOLLOWING HOSPITALIZATION- A RANDOMIZED CONTROLLED TRIAL IN A COMMUNITY-HOSPITAL

Background: The wider use of written advance directives is popular but problematic. We have shown previously that acute hospitalization in t he era of the Patient Self-Determination Act can facilitate directive discussions and documentation. We investigated whether a simple educat ional intervention following hospitalization would increase patients' execution of durable health care proxies. Methods: We studied a consec utive series of patients (n=162) recently discharged from the acute ca re medical service of a community hospital where they had been intervi ewed about advance directives. The intervention group was randomized t o receive an educational brochure and encouragement to execute durable health care proxies. The primary outcome was the proportion of patien ts in each group with completed durable health care proxies on file in their primary physicians' offices. Results: Overall, only 20 (12.3%) of 162 patients had documented proxies, 17 of whom (85%) were 65 years of age or older, with no difference between the intervention and cont rol groups (11 [13.3%] of 83 vs nine [11.4%] of 79, respectively). Sub group analysis of elderly patients also revealed no intervention effec t. Univariate analysis revealed three significant predictors of patien ts' proxy completion: patient age, whether patients had discussed dire ctives in hospital with their physicians, and whether patients' physic ians completed proxies for themselves. Multiple logistic regression an alysis showed that these three variables interact to predict the proba bility of patients' executing proxies.Conclusions: Simple educational interventions,like those mandated by the Patient Self-Determination Ac t, are unlikely to increase patients' completion of durable healthcare proxies. Multidimensional interventions that target both elderly pati ents and their personal physicians should be tested in the future. Dis cussion in hospital about advance directives can be a useful component of such efforts.