title: Multimedia decision support intervention: a promising approach to enhance the intention to complete an advance directive among hospitalized adults.
abstract: OBJECTIVE
  We examined the acceptability and initial efficacy of a multimedia decision support (MDS) intervention to improve intention to complete an advanced directive (AD) among hospitalized adults following an episode of critical illness.
  
  
  METHODS
  We used comparative quasi-experimental posttest only design. Forty-nine hospitalized adults, recovering from a critical illness, received either MDS or AD educational brochure. Demographic characteristics and self-report measures of AD knowledge were captured at baseline and used as covariates. Helpfulness of the intervention (acceptability) and the outcome variable, intention to complete an AD decision, were assessed after exposure to the MDS intervention or educational brochure (information-only control condition).
  
  
  CONCLUSIONS
  The MDS was a more acceptable form of education compared to a brochure. After adjusting for covariates, participants exposed to the MDS intervention were 24.7 times more likely to intend to complete an AD compared to those who were assigned to the information-only control condition.
  
  
  CONCLUSIONS
  This pilot study establishes the acceptability and initial efficacy of the MDS intervention among individuals with critical illness, who are at high risk for hospital readmission life-sustaining treatment. This study illuminates a teachable moment in which patients are more receptive to interventions to complete an AD.
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, Ohio, University Hospitals Case Medical Center, Cleveland, Ohio, School of Nursing, Emory University, Atlanta, Georgia.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hickman
authors.forename: Amy R
authors.initials: AR
authors.lastname: Lipson
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Pinto
authors.forename: Grant
authors.initials: G
authors.lastname: Pignatiello
mesh_terms: D016223:Advance Directives; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019212:Multimedia / Q000706:statistics & numerical data*; D010865:Pilot Projects
keywords: Advance directives; critical illness; decision support; educational interventions; hospitalized adults