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Engaging Homeless Persons in End of Life Preparations

  • Populations at Risk
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Abstract

Background

There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population.

Objective

To determine whether homeless persons will complete an advance directive (AD).

Design

Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG).

Participants

Fifty-nine homeless persons recruited from a drop-in center.

Measures

Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors.

Results

The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05).

Conclusion

This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population.

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Acknowledgements

We are grateful to the director, Rose Marie Reger Rumsey, Mari Uutala, M.A., the staff and the clients of Listening House, St. Paul Minnesota, who so graciously shared their space, their time, and their fears with the research team. Funding for this project was provided by the National Institute for Nursing Research, NIH, 5RO3-NR008586–02, which supported the following: design and conduct of the study, and collection, management, analysis, and interpretation of the data. All authors are responsible for the content of the manuscript, conception and design of the study; acquisition, management, analysis, and interpretation of the data; and critical revision of the manuscript. Drs. Song and Wall are responsible for the drafting of the manuscript, and Dr. Song had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

Dr. Bartels serves as a consultant for Advanced Circulatory Systems on an NIH-funded project, the ResQ trial. None of the other authors have any real or potential conflicts of interests to disclose or report.

Author information

Authors and Affiliations

  1. Center for Bioethics, University of Minnesota, Minneapolis, MN, USA

    John Song MD, MPH, MAT, Edward R. Ratner MD, Dianne M. Bartels RN, PhD & Nancy Ulvestad BSN, MART

  2. Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, USA

    Melanie M. Wall PhD

  3. Department of Medicine, University of Minnesota Medical School, Minneapolis, USA

    John Song MD, MPH, MAT, Edward R. Ratner MD & Dianne M. Bartels RN, PhD

  4. Department of Family Medicine, David Geffen School of Medicine at UCLA, Minneapolis, USA

    Lillian Gelberg MD, MSPH

Authors
  1. John Song MD, MPH, MAT
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  2. Melanie M. Wall PhD
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  3. Edward R. Ratner MD
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  4. Dianne M. Bartels RN, PhD
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  5. Nancy Ulvestad BSN, MART
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  6. Lillian Gelberg MD, MSPH
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Corresponding author

Correspondence to John Song MD, MPH, MAT.

Additional information

This study was funded by the National Institute of Nursing Research, National Institutes of Health, grant RO3 NR008586–02.

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Appendix A

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Song, J., Wall, M.M., Ratner, E.R. et al. Engaging Homeless Persons in End of Life Preparations. J GEN INTERN MED 23, 2031–2045 (2008). https://doi.org/10.1007/s11606-008-0771-1

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