Educating Rural Communities About Advance Directives

Introduction: Advance directives are legal documents that allow patients to convey end-of-life care to their family, medical community, and other important people in their lives. However, a meta-analysis of 150 studies found that only 36.7 percent of the 795,909 sample population had advance directives completed. Limited healthcare resources and low levels of health literacy in rural communities can create challenging medical situations that can be abated by advance directives. Thus, it is imperative to find unique ways to educate and increase the number of advance directives within rural communities. Methods: A presentation and question-and-answer session about advance directives was conducted for adult residents of Eagle Lake, Texas. This occurred in public spaces such community centers and local places of worship. Afterwards, a survey was administered to assess the likelihood of patients creating advance directives. Results: There were 29 participants in the study of which 17 did not have advance directives. Of the 17, 10 were moderately considering or higher to create advance directives prior to the presentation and question-and-answer session. After the enhancement activity, 12 of the 17 were moderately considering or higher to create advance directives. Conclusion: Due to the small population size of the study, the effectiveness of community education on likelihood of completion of advance directives cannot be made. Expanding the population size should be considered in a future study to determine statistical significance. Furthermore, from conversations with participants in the study, several said they would update their existing advance directives due to the presentation. In the future, data should be collected about revaluations of prior written advance directives to have a more complete understanding of the impact of the intervention. From the data gathered, there is a significant percentage of participants that were considering making advance directives but had not done so. A study should be conducted to determine what is limiting rural populations from completing their advance directives.