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

https://doi.org/10.1136/ebm.5.6.182

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    (2000) JAMA 283, 1437. Molloy DW, Guyatt GH, Russo R. , et al. . Systematic implementation of an advance directive program in nursing homes. A randomized controlled trial.. Mar 15;. :. –44..
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 QUESTION: What is the effectiveness of systematic implementation of an advance directive programme in nursing homes?

    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 …

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