Abstract

BACKGROUND:

There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population.

OBJECTIVE:

To determine whether homeless persons will complete an advance directive (AD).

DESIGN:

Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG).

PARTICIPANTS:

Fifty-nine homeless persons recruited from a drop-in center.

MEASURES:

Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors.

RESULTS:

The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05).

CONCLUSION:

This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population.