Advance Care Planning in the Homeless Population

Abstract

Purpose: The purpose of this quality improvement project was to increase knowledge of advance care planning and readiness for advance care planning in the Houston, TX homeless population. Background: The homeless population is at higher risk of mortality due to chronic disease burden, poor living conditions, and mental health issues. Although both the general population and the homeless population benefit from advance care planning, many patients do not participate in advance care planning due to provider mistrust, lack of knowledge, and discomfort with the topic. Methods: This quality improvement project used a quantitative pre-intervention and post-intervention survey single group design to assess knowledge of and readiness for advance care planning before and after participation in a 30-minute educational presentation about advance care planning. Participants were conveniently sampled from the Turning Point Center, a transitional housing center in Houston, TX and descriptive statistics and Wilcoxon signed-rank test were used to analyze data. Results: A one-tailed Wilcoxon signed-rank test with α = 0.05 showed a statistically significant improvement for both knowledge assessment questions and one readiness assessment question. Conclusions: There was an improvement in knowledge of advance care planning and its benefits, as well as readiness to talk to decision makers about medical care during sickness and end of life, but no change in readiness to sign official papers documenting end of life wishes or naming health care proxies.