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An Integrated Review of Research Using Clinical Decision Support to Improve Advance Directive Documentation

Folarinde, Bunmi Yemisi MSN, RN; Alexander, Gregory Lynn PhD, RN, FAAN

Journal of Hospice & Palliative Nursing: August 2017 - Volume 19 - Issue 4 - p 332–338
doi: 10.1097/NJH.0000000000000351
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The Patient Self-determination Act requires that health care institutions inform patients of their right to make health care preferences known through advance directives. However, actual advance directive documentation remains low. This study’s purpose is to identify and analyze research studies incorporating clinical decision support to improve rates of advance directive documentation. In addition, variables impacting advance directive documentation are identified. Literature searches were performed in the Cumulative Index of Nursing and Allied Health Literature, PubMed, and Scopus between 1998 and 2015. Search criteria yielded more than 2000 results using various search engines, yielding 34 articles with 35 studies total. Articles included 17 studies describing electronic health record–based decision support interventions for advance directive documentation (Supplemental Digital Content 1). In addition, 18 studies assessed factors influencing advance directive documentation (Supplemental Digital Content 2). Findings suggest that decision support–based reminders are effective in improving advance directive documentation. Use of e-mail reminders for patients before patient visits through electronic health record portals provides a mechanism to improve advance directive documentation rates. Furthermore, major factors influencing advance directive documentation include inconsistencies in end-of-life preferences between patients and providers and inconsistencies in patients’ preferences over time.

Bunmi Yemisi Folarinde, MSN, RN, is PhD candidate, S415 Sinclair School of Nursing, University of Missouri, Columbia.

Gregory Lynn Alexander, PhD, RN, FAAN, is professor, S415 Sinclair School of Nursing, University of Missouri, Columbia.

Address correspondence to Bunmi Yemisi Folarinde, MSN, RN, S415 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211 (byff48@mail.missouri.edu).

This project was supported by grant number R01HS022497 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jhpn.com).

© 2017 by The Hospice and Palliative Nurses Association.