Provider Education to Facilitate Advance Care Planning Discussions in Primary Care

Abstract

Purpose. The quality improvement project aimed to facilitate advanced care planning conversations through provider education and utilization of available tools in primary care setting.Background. Advance care planning benefits patients and providers by enhancing autonomy and reducing moral distress. However, uptake is low, with only 33% of adults in United States (US) participating. Primary care providers are well-placed to initiate these discussions when patients are healthy. However, 90% of patients say they have never been asked about advance care planning. Barriers include lack of education, time, and fear of distressing patients. Research shows educational interventions can significantly improve provider knowledge and comfort in these conversations. Methods. This quality improvement project occurred at a primary care clinic in Gilbert, Arizona. The design was pre- and post-survey with an on-site educational workshop followed by process change. Workshop was focused on increasing provider knowledge, skills, and confidence in advanced care planning. Participants included all patient-facing staff, consisting of primary care providers and medical assistants. Process change involved application of dot phrase within EMR documentation for patients over 18 with one chronic condition. Data analyzed is from pre- and post-surveys, use of dot phrase, and number of patients asked about advanced care planning. Results. Quality improvement (QI) project involved seven participants who completed pre- and post-surveys, revealing significant gains in advanced care planning (ACP) knowledge (34%), comfort (31%), and self-rated skills (13%). During project, ACP discussions were consistently high (100%) for Medicare Annual Wellness Visits, with an increase from 0% to 4% for non-Medicare annual physicals, making 400% improvement from baseline data. However, use of dot phrase in patient charts remained low, with average utilization rate of 20% over seven weeks, compared to 43% rate of ACP discussions. PDSA cycles showed limited improvement in dot phrase adoption. Conclusions. This quality improvement project demonstrates educational interventions can enhance primary care providers' knowledge, comfort, and skills in facilitating advanced care planning discussions. Despite these positive gains, low utilization of dot phrase suggests documentation tools may require stronger implementation strategies, including administrative support, seamless workflow integration, and sustained provider engagement. Modest increases in advanced care planning discussions outside Medicare annual wellness visits indicates potential for broader practice changes. It highlights need for continued efforts to integrate advanced care planning into routine care for non-Medicare patients. Future initiatives should focus on refining tools like dot phrases and addressing barriers to ensure sustained improvements in advanced care planning conversations.