Attitudes toward advance directives and advance directive completion rates

BACKGROUND: The Patient Self-Determination Act (PSDA) (part of the Omnibus Budget Reconciliation Act of 1990) requires that all healthcare institutions receiving Medicare and Medicaid funds inform patients about their right to participate in healthcare decisions, including their right to have an advance directive. Advance directives (ADs) allow an individual to participate indirectly in future medical care decisions if he or she becomes decisionally incapacitated. Despite passage of this bill and mechanisms within most healthcare institutions to provide this information, the AD completion rate remains low. PURPOSE: The purpose of this study was to identify the significant attitudes and factors that influence the completion of ADs among adult hospitalized patients admitted to medical/surgical units. DESIGN: Descriptive correlational survey design. METHODS: A convenience sample of patients admitted to medical-surgical units during a 2-month period completed face-to-face interviews and completion of the Advance Directive Attitude Survey. FINDINGS: Eighty-two percent of the sample identified having received information on ADs, although hospital policy had it distributed to all patients on admission. Eighteen percent of the sample had completed an AD, and an additional 8% completed an AD after the interview and accompanying education during the interview for a 26% completion rate. The mean attitude toward ADs was slightly positive, and there was no difference in attitude score between those with an AD and those without. IMPLICATIONS: Low completion rates of ADS among the majority of the population and even lower among ethnically diverse individuals despite favorable attitudes toward ADs suggest that there are factors beyond access to information that may influence the decision not to complete an AD. Results of this study are congruent with other research raising the question of whether ADs as currently designed are appropriate for all groups.