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

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 QUESTION: What is the effectiveness of systematic implementation of an advance directive programme in nursing homes?


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


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


1292 patients who were nursing home residents.


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 …

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  • Source of funding: Agency for Healthcare Research and Quality.

  • For correspondence: Dr D W Molloy, Geriatric Research Group, Hamilton Health Sciences Corporation, McMaster University, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada. Fax +1 905 575 5121. A modified version of this abstract and commentary also appears in Evidence-Based Nursing.

  • * See glossary.

  • Information provided by author.