Advanced Directives and End-of-Life Care: Completion, Conversations, and Concerns

Introduction. An Advance Health Care Directive (AD) is a formal document specifying what healthcare actions should be taken in the event that an individual becomes unable to make decisions due to illness or incapacitation. Although Advance Directives can reduce cost and burdens of end-of-life care and help people to receive the healthcare they desire, many have not completed them. Objective. 1. To assess knowledge, attitudes, and barriers to completion of ADs; 2. to identify interventions to improve completion of Advance Directives and knowledge of end-of-life care planning. Methods. A five-item multiple choice survey was developed and distributed door-to-door to 281 households in the three Burlington Housing Authority (Burlington, VT) apartment buildings for senior, disabled, and low-income populations. Results. 43 surveys were completed: 51% were 65 or older; 72% were female. Despite universal concerns about end-of-life care, only 33% of respondents had completed an AD; 35% had never had a conversation about this topic. Common barriers to completion included no prior knowledge of ADs, being too busy, and lack of communication with physicians regarding end-of-life care planning. Respondents expressed that being provided blank AD forms, an informational pamphlet, additional education about ADs, and/or further conversations with a doctor and family or friends would assist them in their end-of-life care planning. Conclusions. Additional interventions are needed to encourage completion of ADs. Public education could raise awareness about the importance of ADs. Primary care physicians should initiate discussions with patients about ADs and end-of-life care planning, offering additional resources and assistance when necessary.