, Volume 12, Issue 7, pp 412-415

Increasing the use of advance directives in medical outpatients

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We studied whether a simple educational intervention would increase patient completion of advance directives and discussions on end-of-life issues.


Randomized, controlled trial.


Outpatient clinic of a teaching hospital.


One hundred eighty-seven outpatients of a primary care internal medicine clinic.


Study subjects attended a 1-hour interactive seminar and received an informational pamphlet and advance directive forms. Control subjects received by mail the pamphlet and forms only.

Measurements and main results

Completion of the advance directive was the main measurement. There were no significant differences in baseline characteristics of either group. Follow-up at 1 month revealed advance directive completion in 38% of study versus 24% of control subjects (p=.04), and discussions on advance planning in 73% of study versus 57% of control subjects (p=.02). Patients most likely to complete the documents were white, married, or attendees at the educational seminar.


Interactive group seminars for medical outpatients increased discussions and use of written advance directives.

Supported by the Department of Clinical Investigations, Walter Reed Army Medical Center.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.