Objective:
To test the efficacy of two intervention methods that aimed to increase the percentage of adult clinic patients who completed
living wills and placed them on file with their physicians within a four-month period.
Design:There were one control and two intervention groups. Surveys were separated by age and gender categories and randomly selected
for the final sample.
Setting:The internal medicine outpatient clinic of a large tertiary hospital.
Participants:All patients who visited the clinic were asked whether they would be willing to fill out a survey. The final sample included
167 adult patients who comprised three study groups.
Interventions:The first intervention relied solely on a booklet that described the Minnesota Living Will Act, general information concerning
advance directives, and medical interventions that could be considered extraordinary if used for a patient in a terminal condition.
The second intervention relied on both the booklet and repeated physician-initiated discussions with the patient about the
probable value of a living will.
Main results:The booklet/physician intervention was found to be significantly more effective than either the booklet-only intervention
or no intervention (p<0.05 and 0.01, respectively).
Conclusions:The physician intervention used in this population could be undertaken in any primary care clinic. Time spent in discussion
before a crisis may be significantly shorter and qualitatively better than time spent in discussion with families who must
make decisions during a crisis.
Key words living wills - advance directives - declaration to physicians - terminally ill
Supported by Abbott Northwestern Hospital, Department of Medical Education.