Advance Directives in Patients Over 60 Years Old: Assessment of Perceived Value and Need For Education in the Outpatient Setting

Abstract

Background: Advance directives have widely been regarded as playing a pivotal role in end-of-life care for patients. This study sought to evaluate the current value and perspective on advance directives in patients greater than 60 years of age visiting outpatient clinics. Methods: A cross-sectional survey study was performed at four different departmental outpatient clinics at Texas Tech University Health Sciences Center in Amarillo, Texas for patients over the age of 60 years who presented during a three-month time frame. In addition to demographic data, the survey collected data on patients’ perspective on and completion of advance directives. Results: 314 patients completed the survey. Non-Hispanic white patients were significantly more likely than those of other racial or ethnic groups to have an advance directive in place (58.8% vs. 28.8%, p<0.001). Married and widowed patients were more likely to have advance directive than those single or separated (57.2% and 63.1% vs. 30.8% and 35.5%, p=0.002). Those with greater than 12 years of education were also more likely to have an advance directive in place than those with 12 or fewer years of education (59% vs. 48%, p=0.042). Patients who received education from their primary care provider about advance directives were more likely to have an advance directive than those who had not received any education (64.7% vs. 44.9%, p=0.01). Conclusion: Education from physicians about the value of having an advance directive is a powerful intervention that can results in a significant increase in completion of advance directives. Specific demographic groups that could benefit from education about the value of advance directives include patients of different racial or ethnic backgrounds, patients who are single or divorced, and patients with limited education. We recommend that physicians work to initiate discussions about end-of-life care with all patients over 60 years of age.