| An advance directive is formal documentation of an individual's end-of-life healthcare treatment choices. It is designed to provide guidance when that individual lacks capacity to make independent decisions. Despite legislation supporting the provision of advance directive information to the general public, studies indicate that advance directive completion rates remain low (5-20%). Five Wishes was developed by the Robert Wood Johnson Foundation to increase advance directive completion. It is a written, verbal, and video intervention that guides adults in a group setting through the advance directive completion process and includes five components of end-of-life healthcare treatment decisions: an advance directive, a healthcare proxy, specific comfort preferences, treatment preferences, and personal information for loved ones. Only anecdotal evidence of the program's effectiveness is available. Advance directive completion is a complex construct derived from theories and concepts found inside and outside of nursing. Variables important to advance directive completion (decision control preference, attitudes toward advance directives, and intent) have not been examined together in the context of advance directive completion. Using a quasi-experimental pretest, post-test wait-list control group design, this study examined the effectiveness of the Five Wishes Education Protocol on improving attitudes toward advance directives and increasing advance directive completion in 144 community-dwelling adults through two healthcare decision-making classes given one month apart and offered to parish nurse and senior center groups (Experimental n = 86, Wait-list control n = 58). Baseline advance directive completion as it relates to intent to complete an advance directive and the relationship between decision control preference and attitudes toward advance directives were studied. The Five Wishes Education Protocol was effective in increasing advance directive completion in the Experimental group (t = 6.769, p = .000, 62.1% increase from baseline). Baseline advance directive completion was significantly related to intent to complete an advance directive (X2 = 14.038, p = .000). No statistically significant relationships were found between (a) the Five Wishes Education Protocol and improving attitudes toward advance directives; and (b) decision control preference and attitudes toward advance directives. Advance directive completion increased using the Five Wishes intervention in community-dwelling adults. |
