Developing a parsimonious model for predicting completion of advance directives.
OBJECTIVE
To develop a theory-based model to assist nurses in promoting self-determination for completion of an advance directive (AD).


METHODS
This descriptive study included data from a convenience sample of 118 community-dwelling older adults in Tennessee, USA. Multinomial logistic regression was used to estimate the influence of 15 factors and covariates on completion of an AD.


RESULTS
The parsimonious model had three significant factors: receiving AD information; attitude index; and health literacy score. Participants were highly likely to complete ADs if they had positive attitudes toward ADs and had received information on ADs. As health literacy increased, the likelihood that participants completed ADs was reduced. This model explained 25% of the variation in AD completion. Chi-square fit for the parsimonious model was highly significant.


CONCLUSIONS
Of 15 factors and covariates that could influence completion of an AD, only receiving information about ADs, having positive attitudes toward ADs, and health literacy significantly affected the likelihood of participants completing ADs. More study is needed on this model and how nurses can assist patients with end-of-life decisions.
Campbell
Mary Judy
MJ
Middle Tennessee State University, School of Nursing, Murfreesboro, TN 37132, USA. jcampbel@mtsu.edu
Edwards
M Jo
MJ
Ward
Karen S
KS
Weatherby
Norman
N
D032722:Advance Care Planning / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003657:Decision Making; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013714:Tennessee