Patient Engagement
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Helping Patients Complete Advance Directives (04:56)

Nudging patients to fill out advance directives can dramatically increase their engagement with these documents, says Scott Halpern, Deputy Director of the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. However, because of laws that require witness or notary signatures, it’s difficult to get people to complete the final step. What can we do?

One thing that works in retirement savings, according to Harvard economist David Laibson, is to have people complete all paperwork in one place, at one time. For example, rather than sending patients home with an advance directive, you could encourage them to fill it out in the waiting room and have a notary available on site to sign and seal it. An appointment reminder could encourage them to bring their spouse, too, with a message such as, “We’re giving people advance directives and this would be a great time for the two of you to fill out this form together.” This streamlines the process and allows people to get everything completed in one sitting. If patients simply go home with the paperwork, not only do they have to go out of their way to get it notarized — a barrier in and of itself — but the document could also get misplaced or fall behind other priorities.

Research shows that while people prefer to combine negative decisions or losses, they prefer to separate positive decisions or gains, adds Dartmouth College marketing expert Punam Keller. They like savoring the idea of something positive happening to them, but they want to be done with negative things as quickly as possible. Keller’s group used this logic to encourage employees to complete a health and wellness assessment. Bundling this assessment with a health benefits initiative more than doubled, within three weeks, the number of employees who actually completed the assessment.

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.

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