Advance Directive Completion
Conditions
Keywords
Advance Directive, Active Choice, Decision making
Brief summary
The overall objective of this project is to assess if an active choice intervention can increase advance directive completion rates.
Detailed 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.
Interventions
BEHAVIORALMandatory active choice
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.
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Participants That Select to Complete an Advance Directive | Baseline - up to 1 year | We will analyze the effects of the active choice intervention on rates of completion. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Participants Who Already Have ADs | Baseline - up to 1 year | — |
| Proportion of Participants Who Return a Signed AD | Baseline - up to 1 year | This measures the proportion of participants who return a signed and printed copy of their AD of those who completed an AD online. |
Other
| Measure | Time frame |
|---|---|
| Participant Selections on ADs and Declination Forms | Baseline - up to 1 year |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Mandatory Active Choice The mandatory active choice group could choose to: complete an AD, confirm prior completion of an AD, or complete a form declining AD completion and indicate their reason(s) for doing so.
Mandatory active choice: the mandatory active choice group, unlike the control group, could not simply skip the task. If they didn't want to complete an AD, they had to fill out a declination form. | 642 |
| Control Participants in the control group could choose to: complete an AD, confirm prior AD completion, or skip the task. | 637 |
| Total | 1,279 |
Baseline characteristics
| Characteristic | Total | Mandatory Active Choice | Control |
|---|---|---|---|
| Age, Continuous | 29 years | 29 years | 29 years |
| Clinical Degree No | 1010 participants | 500 participants | 510 participants |
| Clinical Degree Yes | 269 participants | 142 participants | 127 participants |
| Employment Status Full-time | 933 participants | 464 participants | 469 participants |
| Employment Status Part-time | 346 participants | 178 participants | 168 participants |
| Highest level of education College Degree | 602 participants | 304 participants | 298 participants |
| Highest level of education Graduate Degree | 224 participants | 115 participants | 109 participants |
| Highest level of education High School or Less | 108 participants | 57 participants | 51 participants |
| Highest level of education Missing | 76 participants | 30 participants | 46 participants |
| Highest level of education Some College | 269 participants | 136 participants | 133 participants |
| Race/Ethnicity, Customized Asian | 92 participants | 51 participants | 41 participants |
| Race/Ethnicity, Customized Black | 344 participants | 177 participants | 167 participants |
| Race/Ethnicity, Customized Mixed or Other | 105 participants | 55 participants | 50 participants |
| Race/Ethnicity, Customized Prefer not to answer or missing | 60 participants | 26 participants | 34 participants |
| Race/Ethnicity, Customized White | 678 participants | 333 participants | 345 participants |
| Region of Enrollment United States | 1279 participants | 642 participants | 637 participants |
| Sex/Gender, Customized Female | 333 participants | 186 participants | 147 participants |
| Sex/Gender, Customized Male | 918 participants | 446 participants | 472 participants |
| Sex/Gender, Customized Prefer not to answer or missing | 28 participants | 10 participants | 18 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 642 | 0 / 637 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Proportion of Participants That Select to Complete an Advance Directive
We will analyze the effects of the active choice intervention on rates of completion.
Time frame: Baseline - up to 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mandatory Active Choice | Proportion of Participants That Select to Complete an Advance Directive | 0.35 proportion of participants |
| Control | Proportion of Participants That Select to Complete an Advance Directive | 0.20 proportion of participants |
Secondary
Proportion of Participants Who Already Have ADs
Time frame: Baseline - up to 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mandatory Active Choice | Proportion of Participants Who Already Have ADs | .065 proportion of participants |
| Control | Proportion of Participants Who Already Have ADs | .063 proportion of participants |
Secondary
Proportion of Participants Who Return a Signed AD
This measures the proportion of participants who return a signed and printed copy of their AD of those who completed an AD online.
Time frame: Baseline - up to 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mandatory Active Choice | Proportion of Participants Who Return a Signed AD | .078 proportion of participants |
| Control | Proportion of Participants Who Return a Signed AD | .039 proportion of participants |
Other Pre-specified
Participant Selections on ADs and Declination Forms
Time frame: Baseline - up to 1 year