• Alexander K Leung, Dhruv Nayyar, Manisha Sachdeva, John Song, and Stephen W Hwang.
• Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada alexander.kh.leung@gmail.com.
• Palliat Med. 2015 Sep 1; 29 (8): 746-55.

BackgroundChronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives.AimTo determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completion, and describe end-of-life care preferences in a group of chronically homeless individuals.DesignParticipants completed a survey and were offered an opportunity to complete an advance directive with a trained counselor.ParticipantsA total of 205 residents of a shelter in Canada for homeless men (89.1% of those approached) participated from April to June 2013.ResultsDuration of homelessness was ⩾12 months in 72.8% of participants, and 103 participants (50.2%) chose to complete an advance directive. Socio-demographic characteristics, health status, and health care use were not associated with completion of an advance directive. Participants were more likely to complete an advance directive if they reported thinking about death on a daily basis, believed that thinking about their friends and family was important, or reported knowing their wishes for end-of-life care but not having told anyone about these wishes. Among individuals who completed an advance directive, 61.2% named a substitute decision maker, and 94.1% expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest if there was a chance of returning to their current state of health.ConclusionA counselor-guided intervention can achieve a high rate of advance directive completion among chronically homeless persons. Most participants expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest.© The Author(s) 2015.

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