Impact of Active Choice on Advance Directive Completion Rates

University of Pennsylvania

Status: Completed

Conditions: Advance Directive Completion

Treatments: Behavioral: Mandatory active choice

Study type: Interventional

Funder types: Other

Identifiers

NCT02289105

818456

Details and patient eligibility

About

The overall objective of this project is to assess if an active choice intervention can increase advance directive completion rates.

Full description

Nearly 70% of Americans express the desire to die at home, and most individuals want to avoid aggressive or futile care. Despite this, more than half of Americans die in a hospital. Advance directives provide the opportunity to provide, in advance, one's wishes for end of life care, however their completion rates are low. The overall objective of this project is to assess if an active choice intervention can increase AD completion rates. Eligible participants for this study will be all new employees of the University of Pennsylvania Health System (UPHS) who need to complete their online employment paperwork via the On Boarding portal. Participants will have an advanced health care planning task programmed as part of their On Boarding online employment paperwork. Upon selection of the task, each participant will be directed a designated Advance Healthcare Planning (AHCP) website. Participants will be randomized into either the active choice or control arm of the study and proceed through steps to complete or not complete an AD according to the decision making process of the given study arm. All participants in both groups will have access to additional online and telephone resources thought the entire study for any questions. Participants in the active choice group will be given directions stating they are required to complete either the advanced directive or the declination form in order to complete their On Boarding process. Participants in the control group will be given directions stating that completion of the AD is optional.

Enrollment: 1,279 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• New participants of the University of Pennsylvania Health System who have not yet completed their On Boarding process.
• 18 years of age or older
• Have proficiency in reading, writing, and speaking English

Exclusion criteria

• All new UPHS employees will be enrolled

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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1,279 participants in 2 patient groups

Mandatory active choice

Experimental group

Description:

The mandatory active choice group will be presented two forms at the same time. The first form will be a legally valid AD. The second form will be a declination form. Participants in the intervention arm will be required to complete, and submit either of the two forms the task.

Treatment:

Behavioral: Mandatory active choice

Control

No Intervention group

Description:

Participants in the control group will be presented an AD form only and will be encouraged to complete, and submit the form without having to declare the choice of completing or declining the AD.