University of Florida, Gainesville, FL, USA.
J Prim Care Community Health. 2021 Jan-Dec;12:21501327211000221. doi: 10.1177/21501327211000221.
Completion of an advance directive (AD) document is one component of advanced care planning. We evaluated a brief intervention to enhance AD completion and assess whether the intervention effect varied according to health literacy.
A randomized controlled study was conducted in 2 internal medicine clinics. Participants were over 50, without documented AD, no diagnosis of dementia, and spoke English. Participants were screened for health literacy utilizing REALM-SF. Participants were randomized in a 1:1 ratio to the intervention, a 15-minute scripted introduction (grade 7 reading level) to our institution's AD forms (grade 11 reading level) or to the control, in which subjects were handed blank AD forms without explanation. Both groups received reminder calls at 1, 3, and 5 months. The primary outcome was AD completion at 6 months.
Five hundred twenty-nine subjects were enrolled; half were of limited and half were of adequate health literacy. The AD completion rate was 21.7% and was similar in the intervention vs. the control group (22.4% vs 22.2%, = .94).More participants with adequate health literacy completed an AD than those with limited health literacy (28.4% vs 16.2%, = .0008), although the effect of the intervention was no different within adequate or limited literacy groups.
A brief intervention had no impact on AD completion for subjects of adequate or limited health literacy.
Our intervention was designed for easy implementation and to be accessible to patients of adequate or limited health literacy. This intervention was not more likely than the control (handing patients an AD form) to improve AD completion for patients of either limited or adequate health literacy. Future efforts and research to improve AD completion rates should focus on interventions that include: multiple inperson contacts with patients, contact with a trusted physician, documents at 5th grade reading level, and graphic/video decision aids.
NCT02702284, Protocol ID IRB201500776.
完成预先指示（AD）文件是高级医疗保健计划的一个组成部分。我们评估了一项简短的干预措施，以提高 AD 的完成率，并评估该干预措施的效果是否因健康素养而异。
在 2 家内科诊所进行了一项随机对照研究。参与者年龄在 50 岁以上，没有记录 AD，没有痴呆症诊断，并且会说英语。使用 REALM-SF 对参与者进行了健康素养筛查。参与者以 1:1 的比例随机分配到干预组（接受我们机构的 AD 表格的 15 分钟脚本介绍，阅读水平为 11 年级）或对照组（仅收到无解释的空白 AD 表格）。两组均在 1、3 和 5 个月时收到提醒电话。主要结局为 6 个月时 AD 的完成情况。
共纳入 529 名受试者，其中一半为有限健康素养，一半为足够健康素养。AD 的完成率为 21.7%，干预组与对照组相似（22.4%对 22.2%， = .94）。具有足够健康素养的参与者完成 AD 的比例高于具有有限健康素养的参与者（28.4%对 16.2%， = .0008），尽管在足够或有限的阅读水平组内，干预的效果没有差异。
对于具有足够或有限健康素养的受试者，简短的干预措施对 AD 的完成没有影响。
我们的干预措施旨在易于实施，并为具有足够或有限健康素养的患者提供便利。与对照组（向患者提供 AD 表格）相比，这种干预措施不太可能提高具有有限或足够健康素养的患者的 AD 完成率。提高 AD 完成率的未来努力和研究应侧重于包括以下内容的干预措施：与患者进行多次面对面接触、与值得信赖的医生联系、使用五年级阅读水平的文件以及图形/视频决策辅助工具。
NCT02702284，方案 ID IRB201500776。
