Concepts for whichthey havehas direct influence:Advance directive,Advance planning,Literacy level,Practice health,Participants randomized,Practice implications,Level adults,Adults literacy.
Key People For Advance Directive
An advance directive redesigned to meet the literacy level of most adults: A randomized trial
OBJECTIVE: To determine whether an advance directive redesigned to meet most adults' literacy needs (fifth grade reading level with graphics) was more useful for advance care planning than a standard form (>12th grade level).
METHODS: We enrolled 205 English and Spanish-speaking patients, aged >/=50 years from an urban, general medicine clinic. We randomized participants to review either form. Main outcomes included acceptability and usefulness in advance care planning. Participants then reviewed the alternate form; we assessed form preference and six-month completion rates.
RESULTS: Forty percent of enrolled participants had limited literacy. Compared to the standard form, the redesigned form was rated higher for acceptability and usefulness in care planning, P=0.03, particularly for limited literacy participants (P for interaction =0.07). The redesigned form was preferred by 73% of participants. More participants randomized to the redesigned form completed an advance directive at six months (19% vs. 8%, P=0.03); of these, 95% completed the redesigned form.
CONCLUSIONS: The redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates.
PRACTICE IMPLICATIONS: An advance directive redesigned to meet most adults' literacy needs may better enable patients to engage in advance care planning.Sign-in to see all concepts, it's free!