Advance Directives: Effectiveness of a Structured Process for Documented Patient Preferences at a Health System


Introduction: The Center for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) requires organizations to comply with the Patient Self -Determination Act (PSDA) of 1990 and have written policies and procedures that inform the admitted patient about his/her rights to self-determination and executing an advance directive. In a 2014 published report from the Institute of Medicine (IOM) on Dying in America, it offered opportunities for improving ways to engage patients and families in advance care planning and shared decision making. One such opportunity was having electronic storage of patients’ documents to improve access and effectiveness of the materials.

Objective: This study was to compare advance directives data from a previous study (1999-2002), to post enculturation of structured advance directives process for documented patient preferences during the period of 2011 – 2015. Secondly, to conduct a descriptive and bivariate analysis of the enculturated structured advance directives process during the period of 2011 – 2015 to include relationships to various socioeconomic factors, outcomes of hospitalization, and sentinel events such as need for resuscitative measures.

Methods: This descriptive, comparative analysis included 500 random patients from 4 hospitals and the enculturated descriptive analysis included 302 patients from 6 hospitals. Statistical analyses of the data was done using SPSS 19.0. Comparative data analysis of pre and post study was done using bivariate comparison of proportions; with p-value set at .05.

Results: Comparison of pre and post study showed statistically significantly less patients post with no advanced directives (121, 48%) compared to pre (208, 83%) ( p-value < .05). There was a statistically significant greater number of patients post with institutional advance directives (126, 50%) compared to pre (86, 34%) ( p-value < .05). Fifty-four percent of patients from 2011 – 2015 had an AD and none of them had resuscitative measures when Do-Not-Resuscitate (DNR) status was ordered.

Conclusion: The results demonstrate an effective enculturation of structured advance directives processes at this health system. This enculturated process which includes education for healthcare professionals and the community, facilitates optimal patient, family-centered care.

Implications for Practice: Healthcare professionals can best provide quality, patient family-centered care when patient’s preferences are known through documented advance directives. Education for nurses, case managers, and physicians is essential for goal achievement. Allen, R., Cohn, T. M., Edozie, C., Howard, S., & McCrink, P. (2019). Outcomes comparison of enculturating advance directives process at a health system. SAGE Open Nursing, 5, 1 – 9.

Publication Date


Presented At:

14th Annual BHSF Research Conference

Content Type

Poster Presentation

This document is currently not available here.