title: Influencing advance directive completion rates in non-terminally ill patients: a systematic review.
abstract: OBJECTIVE
  To conduct a systematic review of educational advance care planning interventions directed at patients without terminal illness to determine their influence on the completion rate of advance directives (AD).
  
  
  METHODS
  We searched MEDLINE; Cochrane Library, and reference lists of all pertinent retrieved articles for randomized trials (RCTs), restricted to English language and adults > or =18 years. Two investigators independently and in duplicate determined trial eligibility. We included published RCTs evaluating an educational intervention comprised of at least one of; written, audio, or video materials, or direct counseling, and if an outcome included AD completion rate.
  
  
  RESULTS
  Nine RCTs (N=3,206) were included. Overall, methodologic quality and reporting transparency were poor. The median composite quality score was 5 (range, 0-10). The odds ratios for AD completion rates ranged from 0.41 to 106.0 across the trials (test of heterogeneity P <.001). The summary odds ratio for these educational interventions was 3.71 (95% C.I. 1.46, 9.40). Trials with greater methodologic rigor and reporting transparency produced a more conservative estimate of effect, 2.42 [0.96, 6.10] versus 28.69 [5.08, 162.06] for less rigorous and poorly reported trials (P =.013).
  
  
  CONCLUSIONS
  Advance directive completion rates documenting patient preferences for end-of-life care may be increased by simple patient-directed educational interventions.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Rakesh V
authors.initials: RV
authors.lastname: Patel
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data*; D016223:Advance Directives; D006801:Humans; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design