Impact of Active Choice on Advance Directive Completion Rates

The Impact of Active Choice on Completion Rates of Advanced Directives in New Employees of an Academic University Hospital

The overall objective of this project is to assess if an active choice intervention can increase advance directive completion rates.

Study Overview

• Status: Completed
• Conditions: Advance Directive Completion
• Intervention / Treatment: Behavioral: Mandatory active choice

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.

• Study Type: Interventional
• Enrollment (Actual): 1279
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • University of Pennsylvania

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mandatory 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.	Behavioral: Mandatory 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.
No Intervention: Control; Participants in the control group will be presented an AD form only and will be encouraged to complete, and submit the form without having to declare the choice of completing or declining the AD.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Participants That Select to Complete an Advance Directive	We will analyze the effects of the active choice intervention on rates of completion.	Baseline - up to 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Participants Who Already Have ADs		Baseline - up to 1 year
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.	Baseline - up to 1 year

Other Outcome Measures

Outcome Measure	Time Frame
Participant Selections on ADs and Declination Forms	Baseline - up to 1 year

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Investigators: Principal Investigator: Scott D Halpern, MD, PhD,, University of Pennsylvania

Study record dates

Study Major Dates

• Study Start: November 1, 2014
• Primary Completion (Actual): August 1, 2015
• Study Completion (Actual): October 1, 2015

Study Registration Dates

• First Submitted: November 5, 2014
• First Submitted That Met QC Criteria: November 7, 2014
• First Posted (Estimate): November 13, 2014

Study Record Updates

• Last Update Posted (Estimate): January 27, 2017
• Last Update Submitted That Met QC Criteria: December 1, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: Decision making; Advance Directive; Active Choice
• Other Study ID Numbers: 818456