An Intervention to Improve End of Life Decision Making Among Homeless Persons
Condition: End of Life Decision Making; Advance Care Planning
MeSH terms: Death
Study type: Interventional

Summary: 
      This project is a prospective, randomized controlled trial to improve the end of life
      experience for homeless persons by facilitating the expression of their wishes and
      enhancement of their dignity when facing serious illness, death, or the prospect of dying.
      Our main hypothesis is that homeless persons will engage in this intervention and increase
      rates of advance directive completion.
    

Detailed description: 
      This project is a prospective, randomized controlled trial to improve the end of life
      experience for homeless persons by facilitating the expression of their wishes and
      enhancement of their dignity when facing serious illness, death, or the prospect of dying.
      Our main hypothesis is that homeless persons will engage in this intervention and increase
      rates of advance directive completion.

      Participants were recruited from Listening House, a drop-in center for homeless individuals
      located in St. Paul, Minnesota and represent a convenience sample. Participants were required
      to speak English, not be overtly intoxicated, and have been homeless during the previous six
      months. The study was reviewed and approved by the institutional review board of the
      University of Minnesota. All participants who entered the study gave written and oral consent
      for randomization and data measurement and screening.

      After recruitment and consent, participants were randomized into two intervention arms,
      minimal intervention (MI) and guided intervention (GI). All participants received educational
      materials about advance directives and advance care planning, pre-intervention surveys, and
      an advance care planning document, designated HELP, specifically designed for marginalized
      populations to preserve autonomy and elicit preferences of EOL care.

      All participants completed a baseline written pre-test and survey. For this, they received
      compensation of $5. Those randomized to the minimal intervention were provided the
      opportunity to complete a HELP document if they so desired. Participants randomized to the GI
      group were provided with the written instructions and tools and asked to return to meet with
      investigators for one-on-one counseling and assistance in completion of the HELP document on
      one of several days later during the week of enrollment. Three months after enrollment,
      post-intervention evaluations were sought from both MI and GI subjects. There was no
      financial incentive offered for completion of the HELP form.

      Measurement The primary outcome of interest was the completion of a legally valid advance
      directive, the HELP document, which was measured by inspection of HELP documents as well as
      self-report. Secondary outcomes include knowledge, attitude, and behavior variables measured
      through a questionnaire administered at baseline and at follow-up. Demographic information,
      including education and living situations, was also collected at baseline.
    

Intervention name(s): Guided intervention
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research