The purpose of this research study was to assess the knowledge, attitudes, and experiences related to advance directives (ADs) among HealthPartners (HP) patients of various ages, as well as preferred approaches to initiation of the topic.  Subjects included a random sample of HP medical group clinic patients (age 20-80+), stratified by age decade. Subjects were mailed a letter inviting them to participate in a survey regarding end-of-life care wishes.  The survey included items measuring patient knowledge and experiences related to ADs, attitudes toward ADs, and preferences toward initiation of advance care planning discussions.  Descriptive statistics were used to summarize variables and chi-square tests were run to examine differences by age. 

A total of 187 surveys were completed, 70 by phone and 117 by mail.  Almost all (99%) had heard of the term living will, 58% health care directive and durable power of attorney, and 42% AD.  Approximately one-third of subjects (32%) reported having completed an AD and 5% stated that they were in the process or thinking of completing one. The likelihood of having completed an AD increased with age (p<0.0001). Of those without an AD, 44% reported having talked with someone about their wishes.  Many (62%) subjects felt that it was up to them to bring up the topic of EOL care. Overall 70% of subjects reported that they would feel comfortable if their provider initiated discussion.  Participants 60 and older were more likely to report being “very comfortable” with their provider bringing up the subject compared to those <60 (60% vs. 39%, p=0.0157).  Very few differences were found by age.

About one-third of subjects had completed an AD, similar to estimates in the literature.  Of those without an AD, less than half reported having talked with someone, even informally, about their wishes for EOL care. We found that subjects feel it is their responsibility to raise the issue, but would feel comfortable if the provider initiated the topic. There is much room for improvement in increasing the number of patients who complete an AD, or at the minimum engage in a discussion of their wishes. Ways to involve health care providers in the process should be explored as it appears that patients are receptive to physician-initiated discussions of ADs.

For more information, contact: Jody Jackson
Phone: 952-967-7032
Email: jody.m.jackson@healthpartners.com

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