Journal
PATIENT EDUCATION AND COUNSELING
Volume 69, Issue 1-3, Pages 165-195Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.pec.2007.08.015
Keywords
advance directive; health literacy; communication; decision-making; ethics; health disparities
Funding
- NCRR NIH HHS [K-23 RR16539, K23 RR016539] Funding Source: Medline
- NIA NIH HHS [K23 AG030344, T32 AG000212, AG000212, K23 AG030344-01, 5R01AG023626-02, K07 AG000912, R01 AG023626] Funding Source: Medline
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Objective: To determine whether an advance directive redesigned to meet most adults' literacy needs (fifth grade reading level with graphics) was more useful for advance care planning than a standard form (> 12th grade level). Methods: We enrolled 205 English and Spanish-speaking patients, aged >= 50 years from an urban, general medicine clinic. We randomized participants to review either form. Main outcomes included acceptability and usefulness in advance care planning. Participants then reviewed the alternate form; we assessed form preference and six-month completion rates. Results: Forty percent of enrolled participants had limited literacy. Compared to the standard form, the redesigned form was rated higher for acceptability and usefulness in care planning, P <= 0.03, particularly for limited literacy participants (P for interaction <= 0.07). The redesigned form was preferred by 73% of participants. More participants randomized to the redesigned form completed an advance directive at six months (19% vs. 8%, P = 0.03); of these, 95% completed the redesigned form. Conclusions: The redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates. Practice implications: An advance directive redesigned to meet most adults' literacy needs may better enable patients to engage in advance care planning. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
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