Advance Directives in an E-Health Environment: South Australian Preferences and Baby Boomer Choices

Author: Sandra Bradley

Bradley, Sandra, 2015 Advance Directives in an E-Health Environment: South Australian Preferences and Baby Boomer Choices, Flinders University, School of Medicine

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This thesis explores the willingness of South Australians to embrace personal autonomy in future healthcare decision-making through completion of advance directives (ADs) using the e-Health environment. Advance directives are financial, healthcare and lifestyle documents that provide instructional and/or proxy information to be followed when a person is incompetent or lacks capacity for decision-making. Advance directive documents referred to and measured in this thesis are the four legal documents in South Australia (SA) prior to 1 July 2014: Enduring Power of Attorney (EPA), Enduring Power of Guardianship (EPG), Medical Power of Attorney (MPA) and Anticipatory Direction (Ant Dir) otherwise known as the Living Will (LW).

The projects that comprise this thesis include a systematic literature review; a population survey; and a randomised controlled trial. These three methods of data collection provided a comprehensive overview of the effectiveness of the online environment to assist South Australians with AD completion.

Results of this thesis found that: first, overall SA rates of completion of ADs are low with more financial (EPA and Will) than healthcare directives (EPG, MPA and LW) completed. Secondly, although use and comfort with the online environment is relatively high in South Australia (>65%) that in and of itself does not facilitate completion of ADs. Finally, when two different e-Health methods of AD information (an online education module or email-prompting to complete ADs) were offered to South Australian Baby Boomer participants (born 1946–1965) in the randomised controlled trial; neither method facilitated completions to the point of clinical effect. Instead, there were a number of other factors that detracted from AD completion, such as being too busy or “not the right time”.

Policy makers and others may find results in this thesis useful for education and promotion of these documents in South Australia or for comparison with the new South Australian ACD form.

Keywords: advance directives, e-Health, online, advance care planning, enduring power of attorney, Australia

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2015
School: School of Medicine
Supervisor: Professor Paddy Phillips