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

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.

Josephs M, Bayard D, Gabler NB, Cooney E, Halpern SD. Active Choice Intervention Increases Advance Directive Completion: A Randomized Trial. MDM Policy & Practice. 2018 Feb;3(1):2381468317753127.