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End-of-Life Planning Intervention and the Completion of Advance Directives in Homeless Persons FREE

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The summary below is from the full report titled “Effect of an End-of-Life Planning Intervention on the Completion of Advance Directives in Homeless Persons. A Randomized Trial.” It is in the 20 July 2010 issue of Annals of Internal Medicine (volume 153, pages 76-84). The authors are J. Song, E.R. Ratner, M.M. Wall, D.M. Bartels, N. Ulvestad, D. Petroskas, M. West, A.M. Weber-Main, L. Grengs, and L. Gelberg.

Ann Intern Med. 2010;153(2):I-38. doi:10.7326/0003-4819-153-2-201007200-00001
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What is the problem and what is known about it so far?

Everyone has the right to decide what types of medical care to receive. An advance directive is a legal document that lets people choose what medical treatment to receive in different situations. This is especially important if, at some point, a person is unable to tell their health care providers their wishes because of serious illness or injury. Unfortunately, most Americans have not completed an advance directive, but some groups, like homeless persons, are especially unlikely to have an advanced directive.

Why did the researchers do this particular study?

To compare 2 ways to help homeless persons complete advance directives: individual counseling plus assistance with completing the advanced directive form versus written educational information along with the advance directive form.

Who was studied?

262 homeless persons from 8 sites serving homeless persons in Minneapolis, Minnesota.

How was the study done?

Information about the study was posted in advertisements. Interested homeless persons came to a meeting. Homeless persons who showed that they could make decisions independently were enrolled in the study and randomly assigned to receive either intensive counselor-guided support in completing the advance directive or written information with help reading the advance directive when needed. The study team then counted how many persons returned an advance directive within 3 months that was complete enough to be legal.

What did the researchers find?

Advance directives were completed by 37.9% of persons who received counselor guidance compared with 12.8% of persons who received only the written educational assistance. This difference was statistically significant and was found consistently for all 8 study sites and for most types of patients. In 4 examples of clinical situations, 29% to 34% of participants wanted someone else (such as family) to make decisions for them.

What were the limitations of the study?

The homeless persons in this study were from somewhat more stable living situations and, because they answered an advertisement, were probably more interested in filling out an advance directive than most homeless persons.

What are the implications of the study?

If given personal counseling, about one third of homeless persons will complete an advance directive and identify someone to make treatment decisions for them if necessary. Because completing advance directives is rare in homeless persons, just being given educational materials with the advance directive seems to help a little. This study offers a way to help challenging groups, such as homeless persons, have a record of their wishes for medical care if they become seriously ill.





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