Abstract
The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice care providers to offer new patients information about advance directives. This study examined whether encounters with different types of health care providers were associated with higher odds of completing advance directives by older adults. Data were drawn from the 2012 and 2014 waves of the Health and Retirement Study. Participants were 3,752 U.S adults age 65 and older who reported not possessing advance directives in 2012. At least one hospital stay (OR = 1.39, p < .01), nursing home stay (OR = 1.73, p < .001), and receiving home health/hospice services (OR = 1.59, p < .001) were associated with higher adjusted odds of advance directive completion after controlling for demographic and health covariates. Undergoing outpatient surgery was not significantly associated with advance directive completion (OR = 1.10, p = .38). Approximately 40% of ambulatory surgical procedures take place in freestanding surgery centers. The PSDA does not apply to individual physicians or private clinics. The lack of a legal mandate to provide information to patients admitted to freestanding surgery centers may, at least in part, explain the lack of any significant association between outpatient surgery and advance directive completion. The data suggest the PSDA mandate increases advance directive completion and highlight the potential for improvement in advance care planning promotion targeting patients undergoing outpatient surgery. Given the growth of ambulatory surgery, it may be time to consider amending the PSDA to cover freestanding surgery centers.