|Study (country)||Objectives||Design||Participants||N||Major findings|
|Song et al., 2010  (USA)||To determine whether homeless persons will complete a counselling session on ACP with a social worker and fill out a legal AD.||A single-blind, randomized controlled trial||Homeless persons recruited from 8 sites were randomly assigned to one of 2 groups: a self-guided intervention and a counselor-guided intervention||262||
1. The overall completion rate for ADs was significantly higher in the one-to-one counselling group than in the self-guided group (37.9% vs. 12.8%).|
2. This difference persisted across all of the eight sites and most subgroups.
|Johnson & Stadel, 2007  (USA)||To test the efficacy of a preadmission educational interview by a social worker on the completion of Ads||A quasi-experimental study||Adult orthopedic surgical patients who were admitted to a hospital for hip or knee replacement surgery||54||
1. After the intervention, 43% of patients in the treatment group had a health care proxy on their charts, compared to 6% of those in the comparison group (p < .005).|
2. Age, residence, ethnicity, and diagnosis were found not to have significant impact on signing a health care proxy.
|Pearlman et al., 2005  (USA)||To increase ACP use through an educational and motivational intervention by social workers.||A randomized controlled clinical trial||A sample of veteran patients recruited from 23 providers were randomized into the intervention or control group.||280||
1. Compared to the controls, the intervention patients reported more ACP discussions with their providers (64% vs 38%). Living wills were filed in the medical record twice as often in the intervention group (48% vs 23%).|
2. Provider-patient dyads in the intervention group had higher agreement scores than the control group for treatment preferences, values, and personal beliefs (p < .01).
|Morrison et al., 2005  (USA)||To assess the effect of a ACP intervention directed at social workers on identification and documentation of preferences for medical treatments and on patient outcomes||A randomized controlled trial||Newly admitted long-term care residents were allocated into either an intervention or a control group.||139||
1. Intervention residents were significantly more likely than residents in the control group to have their preferences regarding cardiopulmonary resuscitation (p = .005), artificial nutrition and hydration (p < .01), intravenous antibiotics (p < .01), and hospitalization (p < .01) documented in the nursing home chart.|
2. Control residents were significantly more likely than intervention residents to receive treatments discordant with their prior stated wishes.
|Dipko et al., 2003  (USA)||To examine the effectiveness of group education sessions in increasing completion of ADs||A retrospective cohort control study||A cohort of outpatients was divided into three categories: group participants, individually educated patients, and the patients with no AD education.||13,913||
1. Social work education of any kind resulted in an overall completion rate of 20% versus 2.1% in the non-intervention group.|
2. Group education was twice as effective as an individual social work session, and as effective as multiple sessions, but less time consuming.
|Gockel et al., 1998  (USA)||To evaluate the effect of an educational intervention by social workers on the completion of ADs||An uncontrolled observational study||A convenient sample of outpatients recruited at an ambulatory care setting||203||
1. An educational intervention increases the percentage of individuals who initiate an AD.|
2. Patients with more hospitalizations were more likely not to have an AD.
|Bailly & DePoy, 1995  (USA)||To evaluate a social work program designed to promote older people’s autonomous decision making regarding ADs.||An uncontrolled observational study||A convenient sample of older clients who regularly used family medical care services.||10||1. The results revealed a continuum of willingness among elderly people to address future decision making.|
|Luptak & Boult, 1994  (USA)||To examine the effectiveness of an intervention implemented by a social worker to help frail elders to record AD||An uncontrolled observational study||All patients who visited an experimental geriatric evaluation and management clinic during a period of 14 months.||34||1. 71% of the participants recorded AD. Of these, 96% named a proxy and 83% recorded specific treatment preferences.|