Increasing Advance Directive Rates in Primary Care: Implementation of a Redesigned Form

Background: Less than half of individuals 65 and older have completed an advance directive despite evidence to their benefit. Lack of advance directives can have emotional and financial consequences for the family and individual. A major barrier to advance directive completion is the high literacy level most state sponsored forms are written at, with the average form written at a high school level. Methods: This quality improvement project was a three-month trial to increase the number of advance directive rates at a primary care clinic in the Knoxville area. Five Wishes, written at an 8th grade reading level was given to providers to distribute to patients 65 and older who did not have an advance directive. Demographic data was collected retrospectively via chart reviews. Advance directive rates were collected via follow up phone calls with participants. Data were analyzed using SPSS v. 28. Results: The number of advance directives prior to implementation was three and the number after implementation was also three. Average age of those completing an advance directive was 69.00 ± 4.93. There were no statistically significant differences in gender or average age of those who completed the advance directive. Conclusions: The shorter length of time of the project may have contributed to the completion rate. The literacy level of the redesigned form may have been higher than what some participants at the project site could understand, leading to low advance directive rates. Future projects should focus on ensuring that forms of varying literacy level are available.