Engaging homeless persons in end of life preparations.

<bold>Background: </bold>There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population.<bold>Objective: </bold>To determine whether homeless persons will complete an advance directive (AD).<bold>Design: </bold>Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG).<bold>Participants: </bold>Fifty-nine homeless persons recruited from a drop-in center.<bold>Measures: </bold>Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors.<bold>Results: </bold>The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05).<bold>Conclusion: </bold>This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population. [ABSTRACT FROM AUTHOR]