An advance directive redesigned to meet the literacy level of most adults: a randomized trial.
OBJECTIVE
To determine whether an advance directive redesigned to meet most adults' literacy needs (fifth grade reading level with graphics) was more useful for advance care planning than a standard form (>12th grade level).


METHODS
We enrolled 205 English and Spanish-speaking patients, aged >/=50 years from an urban, general medicine clinic. We randomized participants to review either form. Main outcomes included acceptability and usefulness in advance care planning. Participants then reviewed the alternate form; we assessed form preference and six-month completion rates.


RESULTS
Forty percent of enrolled participants had limited literacy. Compared to the standard form, the redesigned form was rated higher for acceptability and usefulness in care planning, P</=0.03, particularly for limited literacy participants (P for interaction </=0.07). The redesigned form was preferred by 73% of participants. More participants randomized to the redesigned form completed an advance directive at six months (19% vs. 8%, P=0.03); of these, 95% completed the redesigned form.


CONCLUSIONS
The redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates.


CONCLUSIONS
An advance directive redesigned to meet most adults' literacy needs may better enable patients to engage in advance care planning.
Sudore
Rebecca L
RL
Division of Geriatrics, University of California San Francisco and the San Francisco Veterans Affairs Medical Center, CA 94121, USA, United States. rsucsf@yahoo.com
Landefeld
C Seth
CS
Barnes
Deborah E
DE
Lindquist
Karla
K
Williams
Brie A
BA
Brody
Robert
R
Schillinger
Dean
D
D000328:Adult; D016223:Advance Directives / Q000523:psychology* / Q000706:statistics & numerical data; D001294:Attitude to Health; D002755:Choice Behavior; D032882:Comprehension; D032962:Consent Forms / Q000592:standards* / Q000706:statistics & numerical data; D004522:Educational Status; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D015999:Multivariate Analysis; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D012495:San Francisco; D011795:Surveys and Questionnaires