Background and Aims: Older Korean Americans are less likely than other ethnic groups to complete an advance directive. The purpose of this exploratory study was to determine whether a workshop on advance directives would result in increased knowledge, more positive attitudes, and higher completion rates of advance directives.

Methods: Two educational workshops about advance directives were conducted using a nonprobability sample from a senior center (n=31) and a church (n=22) in a predominantly Korean neighborhood. Self-administered questionnaires, in Korean, were administered before (Pre-test) and after (Post-test) the workshop and 14 weeks later (Follow-up).

Results: Subjects were 54.3% female, mean age 66.7 years (SD=7.0, range=50-79), and living in the U.S. 25.2 years (SD=11.1). At Pre-test: 40% had not heard of a health care proxy (HCP); 63.2% had not signed an HCP; 19.6% knew what an advance directive was; 23.8% knew what a living will was, and 17.6% had one; 31.4% and 11.8% had talked with their family or doctor, respectively, about treatment preferences at end-of-life; 21.6% and 23.5% said their family or doctor, respectively, knew what their end-of-life treatment preferences were; only 33.3% agreed that is best to wait until it is necessary to sign an advance directive.

Of seniors who planned to speak with their family or with their doctor at Post-test, 73.3% and 34.3%, respectively, reported they had done so at Follow-up, and 42.4% of those who planned to complete a HCP had done so. Of those who did not know or were unsure what a HCP was at Pre-test, 85% reported that they had a very clear understanding at Post-test, and the remaining 15% said they were somewhat clear. At Follow-up: 32.0% of those who hadn't signed a HCP at Pre-test reported signing one since the workshop; 50% of those who had not discussed their preferences for medical treatment with their family at Pre-test reported that they'd had such a discussion after the workshop; only 20% of seniors who had not discussed preferences for medical treatment prior to the workshop had done so at Follow-up; 42.3% of seniors who answered that their family did not know their medical preferences at Pre-test reported that their families now knew about their preferences; 11% of seniors who answered that their doctor did not know their medical preferences at Pre-test reported that their doctor now knew about their preferences; only 25% of those who at Pre-test said it is best to wait until the situation arises to discuss advance directives now said they did not agree with this.

Discussion: These findings suggest that a workshop may be an effective method for increasing the rate of discussions between Korean American seniors with relatives and physicians, and completion of advance directives. Qualitative approaches can be used to further explicate reasons for low rates of discussing medical preferences and completing advance directives. Replication is needed using an experimental design with a more representative sample, and testing a variety of interventions (workshop, written materials, video, group or individual, and with inclusion of family members).