Choice Sets for Advance Directives
| Status: | Completed |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease, Renal Impairment / Chronic Kidney Disease |
| Therapuetic Areas: | Nephrology / Urology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | July 2014 |
| End Date: | October 2015 |
A Randomized Trial of Expanded Choice Sets to Increase Completion of Advance Directives
There is a large gap between the care seriously ill patients want and the care they receive.
Advance directives (ADs) offer an opportunity for patients to express specific end-of-life
preferences to avoid unwanted care. As promising as ADs may be for improving the quality of
care near the end of life, rates of AD completion remain low and previous efforts to
encourage their completion have had limited success. Principles of behavioral economics,
such as the effects of defaults and other framing effects, may offer a novel approach to
bridge the gap in end-of-life care. The goal of this study is to test whether the framing
effect of expanding choice sets can increase the completion of and specification of choices
within advance directives.
Advance directives (ADs) offer an opportunity for patients to express specific end-of-life
preferences to avoid unwanted care. As promising as ADs may be for improving the quality of
care near the end of life, rates of AD completion remain low and previous efforts to
encourage their completion have had limited success. Principles of behavioral economics,
such as the effects of defaults and other framing effects, may offer a novel approach to
bridge the gap in end-of-life care. The goal of this study is to test whether the framing
effect of expanding choice sets can increase the completion of and specification of choices
within advance directives.
This study has been designed as two sequential randomized trials to test two separate
expanded choice set interventions, with the second randomization enrollment being contingent
on results from the first. All enrolled subjects will be asked if they would like to
complete an advance directive and will have been randomized to receive either an expanded
answer choice set or a standard answer choice, as described in detail elsewhere. Only those
subjects who express a desire to complete an advance directive from both arms will then be
randomized again in a stratified fashion to receive either a standard advance directive or
one with an expanded choice set for the decisions regarding life-sustaining therapy, as
described in detail elsewhere.
expanded choice set interventions, with the second randomization enrollment being contingent
on results from the first. All enrolled subjects will be asked if they would like to
complete an advance directive and will have been randomized to receive either an expanded
answer choice set or a standard answer choice, as described in detail elsewhere. Only those
subjects who express a desire to complete an advance directive from both arms will then be
randomized again in a stratified fashion to receive either a standard advance directive or
one with an expanded choice set for the decisions regarding life-sustaining therapy, as
described in detail elsewhere.
Inclusion Criteria:
- Age 18 or older
- Proficient in English
- Chronic hemodialysis for minimum 90 days
- Does not currently have a living will
Exclusion Criteria:
- Blindness
- Cognitive impairment that prohibits subject's provision of informed consent
We found this trial at
15
sites
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