TLDR: WATCH THE VIDEO (click above)
Update: MyChart DOES have the functionality to allow a patient to directly upload their Advanced Directive, but Sutter Health in CA has not enabled it. Thanks MyChart for clarifying.
Imagine yourself in a hospital bed, unable to speak, hooked up to a machine that's keeping you alive. Your family is there with you and has no idea if you would have wanted this.
It's a nightmare that can be avoided, yet only 37% of people have done the one thing that could prevent it: complete an advance directive.
An advance directive is a legal document. It tells your doctor if you want a ventilator or feeding tube or other life-saving measures. It says who can decide for you if you're incapacitated. This is obviously important, so why do so few of us have an advance directive?
In today's teardown, we find out (hint: it has something to do with the design). 💡
✅ Don’t die without planning for how it will affect your loved ones. This checklist will help you minimize the burden on them. Click below to get started.
The cost of not planning
Advance directives go beyond personal preferences. They have significant implications for the healthcare system. 21% of Medicare's annual spending goes to care in the last year of life. Often, this is expensive hospital stays. An analysis by Arcadia Healthcare Solutions found that dying in a hospital costs around $32,379, while dying at home costs approximately $4,760 (〜7X less).
Without advance directives, patients are more likely to receive aggressive treatments that they might not have wanted. The decision-making defaults to life-saving measures. This causes unnecessary suffering. It also drives up healthcare costs.
Why don't more people complete advance directives?
The traditional view is that it comes down to our beliefs and fears. Some worry that saying they don't want life-extending measures means they won't get any care at all. But as behavioral scientists, we know that our environment and how choices are presented to us influences our decisions.
Think about the process of creating a living will. On many free legal sites, you might see a question like, "Would you like to receive all forms of medical care should your condition become terminal?" This is often pre-selected with a "Yes" in bright neon green. You can't not see it. Rocket Lawyer and LegalZoom approach this differently: Rocket Lawyer defaults to aggressive care, while LegalZoom uses a forced choice, listing "I want my life prolonged" first, which makes people more likely to choose it.
Defaults matter
You might think people would carefully weigh a big decision like this, regardless of how the options were presented to them. But research has found otherwise. In a study by Loewenstein and others involving 132 seriously ill patients, those who received advance directives with comfort care as the default were less likely to choose life-extending measures compared to those who had life-extending care defaulted or no default at all.
Barriers on barriers 🚧
An advance directive is useless if you don't get it to your doctor. In Loewenstein's study, around 30% of participants never gave their completed forms to their doctors. My personal experience with uploading an advance directive to Sutter Health’s MyChart system gave me a clue why. There was only a video and a link to read more to guide me—and no easy way to upload. Customer support just directed me to message my doctor. Getting the right link from him took several rounds of back-and-forth. 😣
From there, it just got harder. An advance directive has to be notarized and witnessed by two people. Why hasn't someone simplified this? The impact on healthcare costs and patient experience is significant, but the system piles friction on friction. ⛔️
💡 3 actionable insights from the teardown:
🛠️ Friction kills: Want to increase adoption? Simplify.
🏥 Incentives count: Strengthen incentives for both patients and healthcare providers to ensure advance directives are completed and used.
🎨 Your design matters: Designers, PMs, and marketers should remember that user preferences are heavily influenced by how choices are presented. If a behavior is important, design for it. It makes a difference.
Advance directives are life-affirming. They make sure our end-of-life wishes are respected. They reduce unnecessary suffering and expenses. We should make them easier.
💬 Thoughts? Share below and join the conversation. See you next time for another behaviorally informed (but hopefully sunnier 🔆) teardown.
✅ Don’t die without planning for how it will affect your loved ones. I made a checklist to help you minimize the burden on them. Click below to get started.
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