Advance Care Planning and Advance Directives: A Multimedia Education Program in Community-Dwelling Older Adults

Abstract

<jats:p> This community-based cluster randomized trial evaluated the efficacy of a 4-week multimedia educational intervention followed by telephone consultations at Weeks 12 and 24 on the selection of a hospice program for end-of-life care and completion of an advance directive (AD) in case of future advanced dementia. One hundred twenty-three cognitively intact older adults from five community centers in Taiwan were randomly assigned to two groups. The study showed that 100% of participants in the intervention group (two community centers, n = 52) selected hospice program care for end-of-life care and signed ADs, whereas those in the control group were less likely to do both ( p &lt; .001). Participants in the intervention group also had a positive change in knowledge, subjective norms, perceived behavioral control, and behavioral intention of advance care planning (ACP) for advanced dementia. The theoretically based multimedia educational program was effective in assisting ACP implementation and completing ADs among community-dwelling older adults. </jats:p>

Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review

“…Interactive, multimedia/multimodal online programs included videos, interactive values questions, and/or written materials, such as ADs, booklets, pamphlets, or workbooks 101‐105 . Three programs were designed for low‐literacy populations 102,106,107 and two for non–English‐speaking participants 23,108 . One study included patient and surrogate interventions, 103 and one included patient and clinician interventions 89,109 …”

“…[101][102][103][104][105] Three programs were designed for lowliteracy populations 102,106,107 and two for non-Englishspeaking participants. 23,108 One study included patient and surrogate interventions, 103 and one included patient and clinician interventions. 89,109 Some written-only interventions included questions about values (i.e., not ADs) designed to initiate conversations with clinicians [110][111][112][113] or included in nursing home records.…”

Factors Associated with Advance Directives Documentation: A Nationwide Cross-Sectional Survey of Older Adults in Korea

“…This suggests that developing ADs is closely related to people’s intention to control their own care and the right to refuse futile treatments [ 30 ]. Existing studies have reported that educational interventions are effective in assisting ACP implementation and AD completion among older adults [ 32 , 33 ]. Among the participants in our study, those who had received an educational program regarding EOL issues at various institutions, including welfare and nonprofit organizations, were also more likely to have ADs.…”

What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials

“…Documentation of ACP/AD: 54 RCTs evaluated documentation of ACP or AD 24 29–31 35 40–43 59 61 64 68 71 74 81 82 86 91 101 110–112 118–148. Of the 34 (63%) showing a positive and significant effect of the intervention on documentation, 20 were high-quality, 24 (71%) were communication interventions24 30 31 35 41 42 59 64 68 91 101 111 112 118–128 including 1 with a decision aid component,118 8 were decision aids only82 86 129–134 and 2 were AD-only interventions 43 135…”