Marked Improvement in Recognition and Completion of Health Care Proxies: A Randomized Controlled Trial of Counseling by Hospital Patient Representatives
Meier, Diane E.
Fuss, Barbara R.
Baskin, Shari A.
Morrison, R. Sean
Archives of Internal Medicine. 1996 Jun 10; 156(11): 1227-1232.
BACKGROUND: Advance directives provide a means for patients to retain influence on their medical care should decisional capacity be lost. Several studies have now demonstrated that advance directives that are completed in the ambulatory care setting are rarely available and recognized when patients are admitted to the acute care hospital. OBJECTIVE: To evaluate a generalizable model for improving recognition of previously completed advance directives and for promoting appointment of health care proxies in hospitalized patients. METHODS: Hospitalized elderly patients were randomly assigned to receive the intervention or usual care (n = 190). Intervention patients with capacity were counseled by hospital patient representatives about advance directives and encouraged to complete health care proxies. Patients with existing proxies had this information noted in their charts. For patients without capacity, counselors reviewed their charts for proxy documentation and if absent, contacted patients' next of kin and private physicians to determine proxy status. Usual care patients were not contacted by patient representatives. RESULTS: Forty-eight percent of intervention patients completed a new proxy or had a previously completed proxy identified compared with 6% of controls (P less than .001). For patients with capacity, 22% of intervention patients had a previously appointed proxy agent identified compared with 6% of controls (P less than .001). Thirty-six percent of intervention patients appointed a proxy decision maker compared with 0% of controls (P less than .02). For patients without capacity, 31% of intervention patients had previously appointed proxies identified compared with 6% of controls (P less than .001). CONCLUSIONS: Counseling by hospital patient representatives is an effective and generalizable means of improving recognition and execution of advance directives in the acute care hospital.
Advance Directives; Aged; Ambulatory Care; Communication; Competence; Counseling; Consent; Evaluation; Evaluation Studies; Family Members; Health; Health Care; Health Personnel; Hospitals; Institutional Policies; Medical Records; Methods; Patient Advocacy; Patient Care; Patient Transfer; Patients; Physicians; Proxy; Records; Statistics; Third Party Consent;
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Marked Improvement in Recognition and Completion of Health Care Proxies: A Randomized Controlled Trial of Counseling by Hospital Patient Representatives Meier, Diane E.; Fuss, Barbara R.; O'Rourke, Donna; Baskin, Shari A.; Lewis, Moshe; Morrison, R. Sean (1996-06-10)