This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Keith L. Stelter, MD; Barbara A. Elliott, PhD; Candace A. Bruno, MA, LSW

Arch Intern Med. 1992;152(5):954-959.

Abstract
Background. —
In December 1991, the Patient Self-Determination Act required health care institutions to provide incoming patients with information about living wills (LWs). Although LWs have been legalized in the majority of states, the number of people with a completed LW remains low. This study was designed to learn some of the reasons that so few people have an LW.

Methods. —
With the use of the health belief model, a questionnaire was designed to characterize the group that already had a completed LW and to identify the barriers older adults perceive in their completion of an LW. Older adults (aged 65 to 90 years) who dined at 10 local nutrition sites were asked to participate. Of the 214 subjects with usable responses, 15% already had executed an LW, 66% planned to complete an LW, and 86% wanted to have an LW. By means of multiple regression and discriminant analysis, the characteristics that defined each group were statistically determined.

Results.—
Two characteristics described those who already had an LW: they were highly educated and did not consider the LW form too long for its purpose. The older adults who planned to complete an LW identified two barriers impeding them: family issues and a need for assistance in completing the form. The majority of the older adults (61%) desired that their physicians initiate discussions with them about an LW.

Conclusions.—
Conclusions from these data yield recommendations for health care providers toward implementing the act; physician-initiated discussions, community programs, and available information and assistance are needed.

(Arch Intern Med. 1992;152:954-959)

Author Affiliations
From the Duluth (Minn) Family Practice Residency Program (Drs Stelter and Elliott) and the Gerontology Department, Duluth Clinic Ltd (Ms Bruno).

Footnotes
Accepted for publication December 16, 1991.

Presented in part before the American Academy of Family Physicians, Washington, DC, September 27, 1991.

Reprints not available.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Planning for End-of-Life Care: Black-White Differences in the Completion of Advance Directives
Gerst and Burr
Research on Aging 2008;30:428-449.
ABSTRACT  

Patients Who Complete Advance Directives and What They Prefer
Nishimura et al.
Mayo Clin Proc. 2007;82:1480-1486.
ABSTRACT | FULL TEXT  

Advance Directives Among Health Care Professionals at a Community-Based Cancer Center
Go et al.
Mayo Clin Proc. 2007;82:1487-1490.
ABSTRACT | FULL TEXT  

Completion of a Durable Power of Attorney for Health Care: What Does Cognition Have to Do With It?
McGuire et al.
Gerontologist 2007;47:457-467.
ABSTRACT | FULL TEXT  

Awareness of living wills in the United Kingdom
Das et al.
Age Ageing 2006;35:543-543.
FULL TEXT  

End-of-Life Decision Making, Organ Donation, and Critical Care Nurses
Daly
Crit Care Nurse 2006;26:78-86.
FULL TEXT  

The value of an ethics history?
Das and Mulley
JRSM 2005;98:262-266.
FULL TEXT  

Brief Communication: The Relationship between Having a Living Will and Dying in Place
Degenholtz et al.
ANN INTERN MED 2004;141:113-117.
ABSTRACT | FULL TEXT  

Which primary care resident is more likely to initiate the discussion of designating a healthcare proxy?
Eloi-Stiven et al.
AM J HOSP PALLIAT CARE 2004;21:111-115.
ABSTRACT  

Advance Directives and Community-Dwelling Older Adults
Hamel et al.
West J Nurs Res 2002;24:143-158.
ABSTRACT  

Clinical Factors That Influence Patients' Desire for Participation in Decisions About Illness
Mansell et al.
Arch Intern Med 2000;160:2991-2996.
ABSTRACT | FULL TEXT  

Preferences for Surrogate Decision Makers, Informal Communication, and Advance Directives Among Community-Dwelling Elders: Results From a National Study
Hopp
Gerontologist 2000;40:449-457.
ABSTRACT | FULL TEXT  

End-of-Life Care Preferences of Patients Enrolled in Cardiovascular Rehabilitation Programs
Heffner and Barbieri
Chest 2000;117:1474-1481.
ABSTRACT | FULL TEXT  

Advance Directives Are More Likely Among Seniors Asked About End-of-Life Care Preferences
Gordon and Shade
Arch Intern Med 1999;159:701-704.
ABSTRACT | FULL TEXT  

Public Information and Private Search: Evaluating the Patient Self-Determination Act
Bradley and Rizzo
Journal of Health Politics, Policy and Law 1999;24:239-273.
ABSTRACT  

The Patient Self-Determination Act and Advance Directive Completion in Nursing Homes
Bradley et al.
Arch Fam Med 1998;7:417-423.
ABSTRACT | FULL TEXT  

Publications in Subspecialty Journals on End-of-Life Ethics
Heffner et al.
Arch Intern Med 1997;157:685-690.
ABSTRACT  

Involvement of Cardiovascular Rehabilitation Programs in Advance Directive Education
Heffner and Barbieri
Arch Intern Med 1996;156:1746-1751.
ABSTRACT  

Advance End-of-Life Treatment Planning
Miles et al.
Arch Intern Med 1996;156:1062-1068.
ABSTRACT  

Factors Promoting Completion of Advance Directives in the Hospital
Cugliari et al.
Arch Intern Med 1995;155:1893-1898.
ABSTRACT  

Implementation of the Patient Self-Determination Act in a Hospital Setting: An Initial Evaluation
Silverman et al.
Arch Intern Med 1995;155:502-510.
ABSTRACT  

Making an advance directive
Robertson
BMJ 1995;310:236-238.
FULL TEXT  

Advance Directives and the Cost of Terminal Hospitalization
Weeks et al.
Arch Intern Med 1994;154:2077-2083.
ABSTRACT  

Increasing Completion of Advance Directives
Small
JAMA 1994;271:1907-1907.
ABSTRACT  

Implementation of Advance Directives: For Physicians, a Legal Dilemma Becomes an Ethical Imperative
McIntyre
Arch Intern Med 1992;152:925-929.
ABSTRACT