Levels of Evidence

The Article: Durbin, C., Fish, A., Bachman, J., & Smith, K. (2010). Systematic review of educational interventions for improving advance directive completion. Journal of Nursing Scholarship, 42(3): 234-231.

Big Idea: Pay attention. This is a systematic review – the mother-load of research. Score! This article examines the results of 12 randomized and four non-randomized studies from numerous disciplines analyzing interventions to improve new advance directive completions, which remains a barrier for the majority of healthcare institutions.

Survey Says!: Bottom line, combined written and verbal interventions improved advance directive completion over single-method written interventions. Unfortunately, the research in this area is still rather weak. Durbin and colleagues point out researchers need to conduct more randomized-controlled studies with diverse patient populations before conducting additional studies comparing actual interventions.

Quotable: “Despite persistent efforts by healthcare providers and agencies, ADs [advance directives] are completed by fewer than one third of adults [references]” (p.234).

“The low numbers of studies per type of educational intervention preclude making prescriptive clinical recommendations” (p.240).

So What?: Both inpatient and outpatient healthcare facilities can learn from this systematic review and work to conduct combined written and verbal interventions and education to increase new advance directive completions. Nurse researchers should take note of the gaps within the literature and work to fill those gaps with randomized-controlled studies so we can better understand which interventions work best to improve care.