Use of chart reminders for physicians to promote discussion of advance directives in patients with AIDS

To determine if use of a physician chart reminder improves the rate of physician-initiated discussion and subsequent completion of advance directives (ADs) in patients with AIDS, a controlled study was conducted with 74 patients with AIDS and ten physicians providing primary care at a university-based hospital clinic. Chart reminders were placed on medical records of intervention patients at each primary care clinic visit for six months. Twelve out of 39 (31%) reminder group patients, but only three out of 35 (9%, p = 0.02) control patients underwent AD discussion with physicians. Further, more subjects in the remainder group completed ADs (28% versus 9%, p = 0.03). Controlling for demographic and clinical factors, only assignment to reminder group was associated with discussion and completion of ADs. Physician-level analysis showed that the effect was physician-dependent. Physician chart reminders are an effective tool for promoting discussion and completion of ADs in patients with AIDS although the effect is physician-dependent.