Effectiveness of Computer-Generated Reminders for Increasing Discussions about Advance Directives and Completion of Advance Directive Forms

Dexter, Paul; Wolinsky, Fredric D.; Gramelspacher, Gregory P.; Zhou, Xiao Hua; Eckert, George J.; Waisburd, Marina; Tierney, William M.

doi:10.7326/0003-4819-128-2-199801150-00005

Cited by 172 publications

(166 citation statements)

References 40 publications

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“…PCP counsels patient for depression, n (%) 41 (20) 16 (23) 13 (19) 12 (19) .9 Antidepressant medication suggested/prescribed or baseline regimen modified, n (%)…”

Section: Discussionmentioning

confidence: 99%

A randomized trial using computerized decision support to improve treatment of major depression in primary care

et al. 2002

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“…PCP counsels patient for depression, n (%) 41 (20) 16 (23) 13 (19) 12 (19) .9 Antidepressant medication suggested/prescribed or baseline regimen modified, n (%)…”

Section: Discussionmentioning

confidence: 99%

A randomized trial using computerized decision support to improve treatment of major depression in primary care

et al. 2002

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“…Two papers reported clinical outcomes (control of blood pressure 24 and rate of venous thrombo-embolism) 29 and all the rest involved process outcomes. One paper 19 reported three different intervention arms and one control arm. This study was entered as three separate comparisons and the numbers in the control arm were divided by three to avoid over-weighting.…”

Section: Selection Of Articlesmentioning

confidence: 99%

“…[16][17][18][19][33][34][35][36][40][41][42]54 The remainder were displayed either exclusively on a computer screen or in both formats. There was no significant difference in the odds ratios obtained between these subgroups.…”

Section: Features Influencing Effect Sizementioning

confidence: 99%

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

2012

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OBJECTIVE: To synthesise current evidence for the influence on clinical behaviour of patient-specific electronically generated reminders available at the time of the clinical encounter. DATA SOURCES: PubMed, Cochrane library of systematic reviews; Science Citation Index Expanded; Social Sciences Citation Index; ASSIA; EMBASE; CINAHL; DARE; HMIC were searched for relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: We included controlled trials of reminder interventions if the intervention was: directed at clinician behaviour; available during the clinical encounter; computer generated (including computer generated paper-based reminders); and generated by patient-specific (rather than condition specific or drug specific) data. STUDY APPRAISAL AND SYNTHESIS METHODS:Systematic review and meta-analysis of controlled trials published since 1970. A random effects model was used to derive a pooled odds ratio for adherence to recommended care or achievement of target outcome. Subgroups were examined based on area of care and study design. Odds ratios were derived for each sub-group. We examined the designs, settings and other features of reminders looking for factors associated with a consistent effect. RESULTS: Altogether, 42 papers met the inclusion criteria. The studies were of variable quality and some were affected by unit of analysis errors due to a failure to account for clustering. An overall odds ratio of 1.79 [95% confidence interval 1.56, 2.05] in favour of reminders was derived. Heterogeneity was high and factors predicting effect size were difficult to identify. LIMITATIONS: Methodological diversity added to statistical heterogeneity as an obstacle to meta-analysis. The quality of included studies was variable and in some reports procedural details were lacking. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:The analysis suggests a moderate effect of electronically generated, individually tailored reminders on clinician behaviour during the clinical encounter. Future research should concentrate on identifying the features of reminder interventions most likely to result in the target behaviour.

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“…In addition, advance care planning may relieve the burden of decision making for caregivers, and facilitate open communication between patients and caregivers. 120,125,129 An advance directive is a statement (either made orally or in writing) by a person that outlines their wishes for future health and personal care. The directive generally becomes effective when the person is unable to make his or her own decisions.…”

Section: Advance Care Planning (Box 11)mentioning

confidence: 99%

Life expectancy discussions in a multisite sample of Australian medical oncology outpatients

Zucca

Sanson‐Fisher

Waller

et al. 2015

Medical Journal of Australia

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Objectives: The study examined: 1) the proportion of patients who received their preferred level of information about life expectancy; and 2) sociodemographic, clinical and psychological factors associated with patients' perceptions of whether they received too little, too much, or the right amount of information about life expectancy. Design: Cross‐sectional survey. Setting: Eleven large Australian medical oncology treatment centres. Participants: A total of 1431 medical oncology outpatients participated (81% consent rate). Eligible patients were approached between September 2012 and May 2014. Main outcome measures: Patients indicated whether the information about life expectancy they received aligned with their preferences. Results: Almost one in four patients (24%) received too little information, 4% received too much, and 50% received all the information they wanted; 22% of patients neither wanted nor received information about life expectancy. Patients were more likely to receive too little information if they were not in remission (odds ratio [OR], 1.77), did not know their cancer stage at diagnosis (OR, 3.64), or were anxious (OR, 1.48) or depressed (OR, 1.48). Patients had greater odds of receiving too much information if they were younger (OR, 1.45), had more advanced cancer (OR, 2.01) or did not know their cancer stage at diagnosis (OR, 4.42). Conclusions: That fact that 28% of cancer patients did not receive their desired level of information about life expectancy highlights the difficulties associated with discussing this sensitive topic. To ensure that life expectancy discussions correspond with patient preferences, clinicians should routinely ask patients whether they want to know this information, in what format, and at which level of detail.

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Effectiveness of Computer-Generated Reminders for Increasing Discussions about Advance Directives and Completion of Advance Directive Forms

Abstract: Simple computer-generated reminders aimed at primary caregivers can increase the rates of discussion of advance directives and completion of advance directive forms among elderly outpatients with serious illnesses.

Cited by 172 publications

References 40 publications

A randomized trial using computerized decision support to improve treatment of major depression in primary care

A randomized trial using computerized decision support to improve treatment of major depression in primary care

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

Life expectancy discussions in a multisite sample of Australian medical oncology outpatients

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