%0 Journal Article
%T Promoting advance planning for health care and research among older adults: A randomized controlled trial
%A Gina Bravo
%A Marcel Arcand
%A Dani¨¨le Blanchette
%A Anne-Marie Boire-Lavigne
%A Marie-France Dubois
%A Maryse Guay
%A Paule Hottin
%A Julie Lane
%A Judith Lauzon
%A Suzanne Bellemare
%J BMC Medical Ethics
%D 2012
%I BioMed Central
%R 10.1186/1472-6939-13-1
%X Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.ISRCTN89993391As the population ages worldwide, growing numbers of older adults develop Alzheimer's disease and related disorders that gradually impair their decision-making capacity [1]. As a result, important health-related decisions end up being made by family members and healthcare providers without direct input from the affected individual [2]. Recent
%U http://www.biomedcentral.com/1472-6939/13/1