Improving Advance Care Planning: An Educational Intervention for Primary Care Providers

Abstract

Purpose This quality improvement project aimed to provide primary care providers with the education and tools to improve their knowledge, confidence, and intention to discuss advance care planning and advance directives with their patients.Background Advance care planning reduces unwanted medical care and patient costs, decreases the likelihood of an in-hospital death, increases end-of-life quality, and decreases hospitalizations and intensive care unit stays. Despite the positive effects of advance care planning, it is estimated that only one in three United States citizens has completed an advanced directive. Primary care providers are well suited to discuss advance care planning with patients before receiving terminal diagnoses. Primary Care Physicians, a primary care practice in Omaha, Nebraska, were not routinely completing advance care planning discussions with their patients unless prompted by the patient. A quality improvement project was planned to improve the providers’ confidence, knowledge, and intent to complete advance care planning discussions with patients. Methods An educational in-service presentation was provided to healthcare providers at Primary Care Physicians focusing on the content of advance care planning and advance directives. Additional resources for providers were provided to help start advance care planning discussions with patients. A post-survey descriptive, quantitative analysis was conducted to evaluate the effectiveness of the educational in-service. Results A total of 5 primary care providers participated in the in-service and completed the post-survey. After participating in the in-service, 100% (n=5) participants responded either “agree” or “strongly agree” with statements that they had increased knowledge and confidence in advance care planning and advance directives. 100% of respondents indicated they will have “more” advance care planning discussions with patients because of the educational in-service. Conclusion The implementation of this educational in-service improved the knowledge, confidence, and intention to have advance care planning discussions for primary care providers. Future recommendations include establishing a process to have advance care planning discussions during each annual wellness visit, providing printed-out resources for patients, updating the presentation's educational content as new evidence-based knowledge and recommendations change, and making the education a required annual review for primary care providers.