The effectiveness of interventions to increase advance directive completion rates

Objectives: Despite federal and state laws governing advance directives (ADs), interventions to increase rates of legally completed ADs have not produced significant results. This study synthesizes the state of the science regarding effectiveness of interventions to increase AD completion rates. Methods: Garrard's method for conducting a systematic literature review was followed. In all, 25 studies meeting inclusion criteria were reviewed. Interventions fell into two types: (a) didactic - information distributed through an educational program or clinical encounter or by a mailing and (b) interactive - person-to-person interaction where participants had the opportunity to ask questions and/or receive assistance completing the forms. Results: Postintervention rates of AD completion were: didactic = no change to 34% increase; interactive = 23% to 71% increase. Discussion: Education without the ability to ask questions does not significantly increase the AD completion rate. Didactic interventions did not usually increase completion rates higher than the predicted average rate for the general population.