Practical methods to increase use of advance medical directives.
OBJECTIVE
To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape.


METHODS
Population-based, randomized controlled trial with 3-month follow up.


METHODS
Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization.


METHODS
A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired.


METHODS
All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives.


RESULTS
The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference -0.04, 0.04, p =.952).


CONCLUSIONS
In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives.
Brown
J B
JB
Center for Health Research, Kaiser Permanente Northwest Division, Portland, OR 97227, USA.
Beck
A
A
Boles
M
M
Barrett
P
P
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005568:Forms and Records Control; D006279:Health Maintenance Organizations / Q000458:organization & administration; D006801:Humans; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014481:United States; D014743:Videotape Recording