Community Engagement to Improve Advance Care Planning Knowledge with Healthy Adults

Abstract

Purpose. This quality improvement (QI) project aimed to improve advance care planning (ACP) knowledge and comfort level in end-of-life (EOL) discussions of healthy adults through an online community engagement session teaching ACP education and playing an EOL conversation game Hello.Background. ACP is highly underutilized, with only 25% of Americans having an advance directive (Weathers et al., 2016). ACP helps people receive care consistent with their values and preferences, which improves quality of EOL care (Weathers et al., 2016). It also reduces healthcare costs by the decreasing utilization of futile healthcare services and burdensome transitions of care (Institute of Medicine [IOM], 2015; Kelley & Bollens-Lund, 2018; Smith et al., 2012). Barriers to ACP include lack of awareness and the belief that it only applies to older, sicker individuals. The coronavirus 2019 (COVID-19) pandemic, however, gave reason for people of all health-states and ages to voice their healthcare priorities in the case of a life-threatening illness. This provided an opportunistic time to normalize ACP, especially for people living near the first COVID-19 outbreak. Methods. Participants were ages 18 to 45, lived within 45 minutes of Bothell, WA, and were self-identified as healthy. Flyers were posted at local businesses and on social media, and disclosure forms and the invitation to an online Zoom meeting were sent to those who volunteered. Pre and posttest surveys via SoGoSurvey were sent to assess baseline and post-engagement session knowledge and comfort level regarding ACP and EOL conversations and assess the stage of change from the transtheoretical model in regards to ACP behavior. Data analysis occurred on Excel. Results. The project was implemented over a 60-minute Zoom meeting. Data analysis showed an increase in ACP knowledge and comfort level discussing EOL, and a forward shift in the stage of change. Seminar evaluation revealed that participants viewed the seminar as worthwhile. Conclusions. Effective dissemination of ACP information and exposure to EOL conversations targeted towards healthy, community-dwelling adults can be successfully accomplished through an online engagement session for the community of Bothell, Washington. Future studies should include participants from a wider variety of locations and results from multiple online sessions.