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The Impact of Active Choice on Completion Rates of...

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


Completing an advance directive (AD) can help inform providers, family members, and surrogates about a patient’s preferences for end-of-life care, reducing the decision-making burden for designated proxies in the event of an adverse health situation. Yet despite the benefits of completing an AD, many patients neglect to enact one. This study is testing an approach whereby subjects are required to complete either an AD or a form declining to do so. This does not force a particular outcome, but simply requires patients to make a decision, thereby countering the procrastination and inertia that often prevent people from doing things they actually want to do.


  • Otto Haas Charitable Trust



Study Status


Results & Impact

Active Choice Results

Participants in the active choice arm were more likely to complete advance directives online (35.1% v. 20.4%) and to return signed and witnessed advance directives by mail (7.8% v. 3.9%).The active choice intervention was significantly more effective among men than among women. Participant age, race, and clinical degree status did not significantly modify the intervention’s effect on advance directive completion. The intervention was not associated with differences in the distributions of responses to any of the eight selections that participants made in their advance directives, including overall preferences for care and choices regarding use of specific interventions. As demonstrated in this study, the use of an active choice intervention motivates engagement by requiring individuals to choose to complete an advance directive or decline to do so, thereby increasing completion rates nearly twofold relative to simply offering people the opportunity to complete an advance directive.


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