Understanding Of Advance Directives Research Articles

A nurse practitioner-led community workshop: Increasing adult participation in advance care planning.

Advance directives (ADs) and advance care planning (ACP) aid in expressing an individual's preferences and guide future medical decision-making. Despite the potential of ADs and ACP to positively impact care, consistently low rates of ADs and ACP (5%-39%) have been documented. The purpose of this project was to increase understanding and participation in the ACP process among rural-dwelling community members. A pre-post repeated measures design with an evaluation component to measure understanding, completion, discussion, and dissemination of ADs and ACP. A sample of N = 40 were recruited to participate in a one-time nurse practitioner-led Five Wishes workshop delivered in a community setting. Postworkshop evaluations indicated an overall acceptance and understanding of ADs and ACP. Completion rates of ADs and discussion in the ACP process significantly increased at 1-month follow-up. Nurses and advanced practice nurses are well positioned to educate individuals and facilitate the ACP process. There is a need to educate individuals on importance of sharing their AD wishes with their family and primary care provider. This nurse practitioner-led workshop using the Five Wishes demonstrated the feasibility and potential effectiveness of initiating the ACP process in the community.

Does Preparedness Planning Improve Attitudes and Completion of Advance Directives in Patients with Symptomatic Heart Failure?

There is little evidence to support whether interventions that engage patients with symptomatic heart failure (HF) in preparedness planning impacts completion of advance directives (ADs). This study was conducted to assess the impact of a palliative care intervention on health perceptions, attitudes, receipt of information and knowledge of ADs, discussion of ADs with family and physicians, and completion of ADs in a cohort of patients with symptomatic HF. Thirty-six patients hospitalized for HF decompensation were recruited and referred for an outpatient consultation with a palliative care specialist in conjunction with their routine HF follow-up visit after discharge; telephone interviews to assess health status and attitudes toward ADs were conducted before and 3 months after the initial consultation using an adapted version of the Advance Directive Attitude Survey (ADAS). Information pertaining to medical history and ADs was verified through medical chart abstraction. The current study found support for enhancing attitudes and completion of ADs following a palliative care consultation in patients with symptomatic HF. Despite a significant increase in attitudes toward completion of ADs following the intervention, only 47% of the participants completed ADs. This finding suggests that although education and understanding of ADs is important and can result in more positive attitudes, it does not translate to completion of ADs in all patients.

Elderly patients' understanding of advance directives.

Growing evidence suggests that advance directives (ADs) are often ineffective. Further explanation of how these documents are viewed by the public, the expectations of how decisions about treatment are made, and, in particular, patients' understanding of how ADs are actually used in the clinical setting, are warranted. This article details a descriptive study in which patients were interviewed, during hospital stays, about their beliefs and understanding of advanced directives, as well as the processes used in completing them. The study was undertaken in a community hospital located in a rural area in the Midwest. Findings show that many patients were able to clearly articulate what an AD means in terms of making their choices known. However, misconceptions were found in patients' understanding of ADs and only 46% reported discussing their ADs with a physician. Strategies for effective implementation of education programs related to ADs are detailed here.