Evid Based Nurs 3:125 doi:10.1136/ebn.3.4.125
  • Treatment

An advance directive programme in nursing homes reduced health services use without affecting patient satisfaction

 QUESTION: Does systematic implementation of an advance directive programme in nursing homes affect patient and family satisfaction and reduce healthcare costs?


Randomised {allocation concealed}*, blinded {residents}*, controlled trial with 18 months of follow up.


6 nursing homes in Ontario, Canada, each with >100 residents.


1292 nursing home residents.


6 nursing homes were matched in pairs on key characteristics and randomised 1 home per pair to either an advance directive programme (3 intervention homes, 636 patients) or to continue with usual policies of advance directives (3 control homes, 656 patients). The intervention homes used an advance directive programme called Let Me Decide (LMD), which consisted of healthcare choices related to life threatening illness, cardiac arrest, and nutrition. The LMD advance …

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