title: Systematic review of educational interventions for improving advance directive completion.
abstract: OBJECTIVE
  To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another.
  
  
  METHODS
  Systematic review of literature based on Cochrane review criteria.
  
  
  METHODS
  Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies.
  
  
  RESULTS
  Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly.
  
  
  CONCLUSIONS
  Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken.
  
  
  CONCLUSIONS
  This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed.
authors.affiliation: Epsilon Eta, Assistant Professor, School of Nursing, Southern Illinois University-Edwardsville, Edwardsville, IL, USA. cdurbin@siue.edu
authors.forename: Christine R
authors.initials: CR
authors.lastname: Durbin
authors.forename: Anne F
authors.initials: AF
authors.lastname: Fish
authors.forename: Jean A
authors.initials: JA
authors.lastname: Bachman
authors.forename: Katharine V
authors.initials: KV
authors.lastname: Smith
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003657:Decision Making; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013664:Teaching Materials; D017749:Total Quality Management / Q000458:organization & administration; D014743:Videotape Recording