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An advance directive programme in nursing homes reduced health services use without affecting patient satisfaction

Design
Randomised {allocation concealed^*}, {blinded (patients)},^* controlled trial with 18 months follow up.

Setting
6 nursing homes in Ontario, Canada, with >100 residents each.

Patients
1292 patients who were nursing home residents.

Intervention
6 nursing homes were matched in pairs on key characteristics, and within each pair, each home was randomised to either an advance directive programme (3 intervention homes, 636 patients) or to usual policies of advance directives (3 control homes, 656 patients). The intervention homes used an advance directive programme called Let Me Decide (LMD), which consisted of healthcare choices related to life threatening illness, cardiac arrest, and nutrition. The LMD advance directive programme involved educating hospital and nursing home staff, patients, and families about advance directives. Head nurses on each ward classified patients as being mentally competent, incompetent, or "otherwise"; competent patients and next of kin of incompetent patients had the choice of completing the LMD advance directive. . . . [Full text of this article]

Claudia Beghe, MD

University of South Florida Tampa, Florida, USA