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ContextAlthough advance directives are commonly used in the community, little is known about the effects of their systematic implementation.ObjectivesTo examine the effect of systematically implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs.DesignRandomized controlled trial conducted June 1, 1994, to August 31, 1998.Setting and ParticipantsA total of 1292 residents in 6 Ontario nursing homes with more than 100 residents each.InterventionThe Let Me Decide advance directive program included educating staff in local hospitals and nursing homes, residents, and families about advance directives and offering competent residents or next-of-kin of mentally incompetent residents an advance directive that provided a range of health care choices for life-threatening illness, cardiac arrest, and nutrition. The 6 nursing …