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A Randomized, Controlled Trial

Susan M. Rubin, MPH; William M. Strull, MD; Michael F. Fialkow; Sarah J. Weiss, MS; Bernard Lo, MD

JAMA. 1994;271(3):209-212.

Abstract
Objective.
—Wider use of written advance directives may prevent many ethical dilemmas about life-sustaining interventions for patients who have lost decision-making capacity. We investigated whether a simple educational intervention increased patient completion of the durable power of attorney for health care.

Design.
—A randomized, controlled trial.

Setting.
—A health maintenance organization.

Subjects.
—All patients aged 65 years and older and discharged from a hospital between January 1991 and May 1991 (n=1101) were randomized to either an intervention group or a control group.

Intervention.
—An educational pamphlet on the durable power of attorney for health care and a durable power of attorney for health care form were mailed to all patients in the intervention group. The control group received conventional care only.

Main Outcome Measure.
—Completion of the durable power of attorney for health care form.

Results.
—There were no significant baseline differences between the intervention group and the control group. Following our intervention, 18.5% of the subjects in the experimental group completed a durable power of attorney for health care form, compared with 0.4% of the control group (P<.0001).

Conclusions.
—A simple educational intervention significantly increased the completion of the durable power of attorney for health care. Our findings should stimulate further efforts to empower patients to make informed decisions about their health care.

(JAMA. 1994;271:209-212)

Author Affiliations
From the Division of General Internal Medicine, Department of Medicine, and Program in Medical Ethics (Ms Rubin, Dr Lo, and Mr Fialkow), the Center for AIDS Prevention Studies (Ms Rubin and Dr Lo), and the Robert Wood Johnson Clinical Scholars Program (Dr Lo), University of California, San Francisco; Kaiser Permanente Medical Center, San Francisco (Dr Strull); and The Permanente Medical Group, Oakland, Calif (Ms Weiss).

Footnotes
Reprint requests to University of California, Prevention Sciences Group, Box 0886, San Francisco, CA 94143 (Ms Rubin).

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