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Evaluation of the Awareness and Prevalence of Advance Directives in the San Francisco Bay Area

1 August 2004


Context: Advance Directives (ADs) implies to two types of legal documents; 1) living will (L W), and 2) power of attorney for healthcare (PARC). These documents permit one to give instructions about the medical care desired in the event that one becomes unable to communicate or speak: for themselves due to serious illness or incapacity. Objective: To evaluate the awareness and prevalence of ADs in the San Francisco Bay Area. To increase public awareness and education about end-of-life options. Design: Survey questionnaires were distributed between 5/1/04 through 6/1/04 to evaluate several parameters that reflect whether subjects have heard about ADs before, if subjects have ADs, influential factors and its importance of having ADs. Setting: This study primarily took place at an internal medicine office in Daly City, California. Surveys were also distributed to other primary ,care clinics and laboratories within the San Francisco Bay Area to increase survey response and patient distribution. Subjects: A 185 random sample survey were obtained. Participants met inclusion criteria of age, which is 18 years or older, and have the ability to read and speak English. Main Outcome Measures: The percentage of subjects who have heard of and have obtained ADs, sources of where subjects heard about ADs, influential factors in obtaining ADs, who subjects have chosen as second in line in their PARC, as well as importance of attaining such documents. For subjects who have no knowledge or have not obtained ADs, secondary outcome measure include percentage, of subjects who would like to learn more about ADs, why they would like to learn more about ADs, and if they would ask their health care provider about ADs at their next visit. Results: Of the 185 subjects, 131 have heard of ADs prior to taking the survey, but only 34% of those subjects have some form of ADs. Non-Whites, college graduates, those who have children and speaks English as their primary language are more likely to have heard about ADs. The elderly and those who have children are more likely to have some form of ADs. College graduates and. those who are in good health condition are more likely not to have some form of ADs. Family is the most influential factor in obtaining ADs. About two-thirds of those who have not heard of ADs are interested in learning more about them. Conclusions: This study indicates there's a need for more patient education about ADs to increase awareness and prevalence of ADs. Cooperation and coalition between individuals, family members, healthcare providers and hospitals/clinics are needed to expand awareness and prevalence of ADs in the San Francisco Bay Area.


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