Abstract

One of the concerns with advance directives as a means for promoting advance care planning is that advance directives are unreliable as a mechanism for articulating and documenting an individuals values and wishes. Making Your Wishes Known (MYWK) is an interactive computer program that guides people through the process of advance care planning; explains health conditions and interventions that commonly involve life or death decisions; helps individuals articulate their values/goals; and translates users' preferences into a detailed advance directive document. This pilot study examined whether (in the absence of major life changes) the advance directive generated by MYWK reliably reflects an individual's values and preferences. English speakers ≥ 30 years old were recruited from a single community center; screened for reading level, depression, and cognitive ability; and asked to complete MYWK twice, 4-6 weeks apart. Reliability indices were assessed for 3 advance directive components: General wishes; Specific wishes for treatment; and Quality of life values (QoL). The 24 study participants who completed the study were predominantly female (79%) and older (mean age = 68 years). Under classical theory testing, both the Specific Wishes and QoL scales had high internal consistency in both time periods (KR-20 = 0.83-0.95, 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's =0.83), but lower for Specific Wishes (Pearson's=0.57). This pilot study provides evidence that a computer-based decision aid can generate advance directives whose General Wishes and QoL (but not Specific Wishes) statements remain consistent over time.