Learning Objective #1: 1. Describe relationships between the four constructs of the transtheoretical model related to health care proxy completion.

Learning Objective #2: 2. Discuss application of the model relative to promoting health care proxy completion.

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Despite federal and state legislation, the number of persons completing advance directives has not significantly increased since those laws were enacted. Model-guided interventions are needed to increase the proportion of the population with a completed health care proxy (HCP), regardless of ethnic, social, or economic background. The presence of a health care proxy can help ensure the timely delivery of care and medical services to persons in treatment, honor their self-determined wishes, and thus protect their health status. The study, Transtheoretical Model and Health Care Proxies (DHHS/NIH NINR- R21 NR008594A) was conducted to develop four Transtheoretical Model-related measures, establish their psychometric properties, test predicted relationships between them, and develop models to guide interventions. A random sample of 566 individuals insured by two health insurance companies was found to be distributed across four stages of change according to readiness to complete a health care proxy (HCP): 14.3% in precontemplation (no intention of completing a HCP), 41.7% in contemplation (considering completing a HCP in the next 6 months), 7.6% in preparation (considering completing a HCP in the next 30 days), and 36.4% in action (have completed a HCP).   Separate ANOVAs were used to test the expected relationships between the stages of change and 1) processes of change, 2) decisional balance, and 3) self-efficacy.  Predicted relationships were found for decisional balance self-efficacy, but not for the processes of change.  The findings suggest that psychological and tangible support must be provided in tandem as people weigh the benefits and consequences of HCP completion. The resultant models can be used to guide interventions tailored to a person’s readiness to complete a HCP. Further investigation is needed to determine if the models are upheld in other populations.