Encouraging Healthcare Proxy Designation for Older Adults and Adults With Serious Illness

This trial explores methods to encourage older adults and those with serious illnesses to choose a healthcare proxy, someone who makes medical decisions if the patient cannot. Participants will receive various types of mailers before a healthcare appointment; some mailers will include a pre-commitment prompt to bring a healthcare proxy form. The trial aims to determine which type of mailer most effectively encourages individuals to make this important decision. It is ideal for individuals over 55 or those with cancer, heart failure, or kidney disease who have not yet designated a healthcare proxy. As an unphased trial, this study offers a unique opportunity to contribute to research that could simplify crucial healthcare decisions for many.

The trial information does not specify whether you need to stop taking your current medications.

Studies have shown that mailers used in healthcare are generally safe and well-received. Research on the Health System Mailer suggests that efforts to improve care transitions can enhance health outcomes without major risks. For the Provider Mailer, studies report few negative effects and high satisfaction among patients and healthcare providers. The Pre-commitment Prompt, which reminds patients to bring forms to their appointments, is part of a larger effort to increase patient involvement and is considered safe. Overall, these mailer interventions focus on communication and encouragement, which typically do not pose safety concerns.¹²³⁴⁵

Researchers are excited about this trial because it explores innovative ways to encourage older adults and those with serious illnesses to designate a healthcare proxy. Unlike traditional methods that rely heavily on in-person discussions during medical appointments, this trial tests the effectiveness of using mailers, both from health systems and individual providers, to prompt patients to take action. Some mailers include a pre-commitment prompt, which nudges patients to bring a completed healthcare proxy form to their next primary care visit. This approach could streamline the process and increase the number of patients who designate a healthcare proxy, ultimately improving patient autonomy and ensuring their healthcare wishes are respected.

Research has shown that planning ahead for medical care, such as choosing someone to make healthcare decisions, can improve patient outcomes. This trial evaluates different methods to encourage healthcare proxy designation. One arm sends a mailer without a pre-commitment prompt, while another includes a pre-commitment prompt. Studies have found that mailing information about planning for future medical care increases conversations and written records about end-of-life wishes. Specifically, one study found that 12% of patients who received this information created new documents about their wishes, compared to 6.6% who did not. Including a prompt to commit to planning in these materials has also been linked to more patients receiving care that aligns with their goals. These methods help ensure that a person's wishes are respected when they cannot communicate them themselves.⁶⁷⁸⁹¹⁰