More Homeless Finish Advance Directives With Intervention

One-on-one assistance with counselor, social worker increases rate of completion
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, July 20 (HealthDay News) -- Counselor-assisted end-of-life planning for homeless people significantly increases the rate of completion of advance directives in this population, according to research published in the July issue of the Annals of Internal Medicine.

John Song, M.D., of the University of Minnesota in Minneapolis, and colleagues conducted a prospective, single-blind, randomized trial comparing self-guided completion of an advance directive to professionally assisted advance care planning in 262 homeless individuals. The self-guided intervention consisted of supplying written educational materials along with an advanced directive form, while the complex intervention included one-on-one counselor guidance and assistance completing an advance directive from a social worker.

The researchers found a higher rate of completion of the advance directive forms in the counselor-guided group (37.9 percent) than in the self-guided group (12.8 percent). The overall completion rate was 26.7 percent. Of the four scenarios included in the advance directives, 29 to 34 percent of the study population preferred that a surrogate make end-of-life decisions for them.

"Our study shows that persons with substantial economic and social disadvantages can be engaged in autonomy- and dignity-preserving behaviors, such as completing an advance directive with end-of-life preferences through an interactive, personalized intervention," the authors write.

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