title: Chronically homeless persons' participation in an advance directive intervention: A cohort study.
abstract: BACKGROUND
  Chronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives.
  
  
  OBJECTIVE
  To determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completion, and describe end-of-life care preferences in a group of chronically homeless individuals.
  
  
  METHODS
  Participants completed a survey and were offered an opportunity to complete an advance directive with a trained counselor.
  
  
  METHODS
  A total of 205 residents of a shelter in Canada for homeless men (89.1% of those approached) participated from April to June 2013.
  
  
  RESULTS
  Duration of homelessness was ⩾12 months in 72.8% of participants, and 103 participants (50.2%) chose to complete an advance directive. Socio-demographic characteristics, health status, and health care use were not associated with completion of an advance directive. Participants were more likely to complete an advance directive if they reported thinking about death on a daily basis, believed that thinking about their friends and family was important, or reported knowing their wishes for end-of-life care but not having told anyone about these wishes. Among individuals who completed an advance directive, 61.2% named a substitute decision maker, and 94.1% expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest if there was a chance of returning to their current state of health.
  
  
  CONCLUSIONS
  A counselor-guided intervention can achieve a high rate of advance directive completion among chronically homeless persons. Most participants expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest.
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada alexander.kh.leung@gmail.com.
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Leung
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Nayyar
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Manisha
authors.initials: M
authors.lastname: Sachdeva
authors.affiliation: Center for Bioethics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: John
authors.initials: J
authors.lastname: Song
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data*; D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D002170:Canada; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*; D055815:Young Adult
keywords: Advance directives; advance care planning; end-of-life care; homeless persons; patient preference; terminal care