Elderly hands interacting with an Advance Directive app on a digital tablet.

Navigating End-of-Life Decisions: How to Complete Advance Directives Effectively

Theo Raines in Health & Wellness November 2025 • 4 min read.

"Explore the most effective methods for Baby Boomers to complete Advance Directives, including the impact of online formats and email prompting in a randomized controlled trial."

Planning for end-of-life care is a crucial aspect of ensuring your wishes are honored, especially when you're unable to communicate them yourself. Advance Directives (ADs), which include financial and healthcare proxies, and instructional documents, are essential tools for this purpose. However, studies show that completing these documents is relatively uncommon.

To tackle this issue, researchers have explored various methods to encourage the completion of ADs, focusing on online education and prompting. Past literature indicates that these strategies can be effective, but questions remain about how to optimize them for different generations. This article delves into a randomized controlled trial that assesses the impact of computer-based online AD information and email prompting on Australian Baby Boomers (born 1946–1965).

The study aims to identify the most effective online formats for assisting this demographic in completing their ADs, as well as pinpointing the factors that may either impede or assist their completion of these critical documents within the online environment.

Online Education vs. Email Prompts: What Works Best for AD Completion?

Elderly hands interacting with an Advance Directive app on a digital tablet.

A recent study explored the effectiveness of online interventions—specifically, online education modules and email prompts—in encouraging Baby Boomers to complete their Advance Directives (ADs). The trial randomly assigned 282 participants aged 49–68 into different intervention groups. These groups included an education module only, an email prompt only, a combination of both, and a control group with no intervention.

The primary goal was to determine which method, if any, significantly increased the completion rate of the four legal ADs in South Australia within a 12-month period. Secondary outcomes focused on understanding the reasons for non-completion and the factors influencing participants' engagement with ADs in an online setting. Here’s a detailed look at the findings:

Low Completion Rates: The study revealed that only 7% of participants completed one or more of the four legal ADs within the 12-month follow-up period.
No Significant Difference Between Groups: There was no statistically significant difference in completion rates between the intervention groups (email prompt, education module, or both) and the control group.
Common Reasons for Non-Completion: The most frequently cited reasons for not completing ADs were being too busy (26%) and feeling that it wasn't the right time (21%).

These findings suggest that neither email prompting nor the provision of additional online educational material was sufficient to significantly impact AD completion rates for Baby Boomers in this context. It underscores the complexities involved in encouraging this demographic to engage with end-of-life planning through digital means.

Future Directions: Enhancing Engagement with Online AD Tools

Given the study's results, future research should focus on exploring online preferences for engaging with ADs over longer periods, potentially uncovering better insights into how to use this environment effectively. Continued investigation into how technology can support end-of-life planning for different generational cohorts is essential to improving completion rates and ensuring individuals' wishes are respected.

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Everything You Need To Know

What are Advance Directives (ADs), and why are they important for end-of-life planning?

Advance Directives (ADs) are crucial tools that include financial and healthcare proxies, along with instructional documents. They are essential for planning end-of-life care, ensuring that your wishes are honored, especially when you're unable to communicate them yourself. Without Advance Directives, decisions might be made by others who may not know or understand your preferences. The study explores methods to encourage the completion of Advance Directives using online education and email prompting.

What did the study reveal about the effectiveness of online education modules and email prompts in helping Baby Boomers complete their Advance Directives?

The study found that neither online education modules nor email prompts significantly increased the completion rate of Advance Directives (ADs) among Baby Boomers. Only 7% of participants completed one or more of the four legal ADs within the 12-month follow-up period, and there was no statistically significant difference between the intervention groups (email prompt, education module, or both) and the control group. The reasons cited for non-completion included being too busy and feeling that it wasn't the right time.

What were the primary reasons participants in the study gave for not completing their Advance Directives?

The most frequently cited reasons for not completing Advance Directives were being too busy (26%) and feeling that it wasn't the right time (21%). These reasons suggest that time constraints and emotional readiness play significant roles in whether individuals engage with end-of-life planning, regardless of the availability of online resources like educational modules or email prompts designed to encourage completion.

Given that online education and email prompts weren't significantly effective, what future research directions are suggested to enhance engagement with Advance Directives?

Future research should focus on exploring online preferences for engaging with Advance Directives over longer periods to uncover better insights into how to effectively use this environment. Continued investigation into how technology can support end-of-life planning for different generational cohorts is essential to improving completion rates and ensuring individuals' wishes are respected. This might involve personalized approaches, interactive tools, or addressing the barriers of time and emotional readiness.

How does this research emphasize the complexities of encouraging Baby Boomers to engage with end-of-life planning through digital means, specifically concerning Advance Directives?

This research underscores that simply providing online education or email prompts is insufficient to significantly impact Advance Directives (ADs) completion rates for Baby Boomers. The study's findings highlight the importance of understanding the nuances of this demographic's online behavior and their emotional and time-related barriers to engaging with end-of-life planning. Future strategies need to be more tailored and address the specific reasons for non-completion, such as busy schedules and feeling unprepared to confront mortality, rather than relying on generic digital interventions.