Abstract

Background and Review of Literature: Advance directives (AD) are documents that offer patients a way to avoid unwanted care in the event of a serious illness or incapacity. Studies demonstrate the care patients receive at the end-of-life is not often consistent with their preferences, as a result of suboptimal communication between the patient and provider as well as documentation of health care proxies and treatment preferences (Isaac & Curtis, 2016). The lack of a current formal protocol used by primary care providers regarding ADs, particularly towards the young adult patient population, resulting in insufficient discussions of patients’ wishes regarding end-of-life healthcare decisions is troubling (Stuart, Volandes, & Moulton, 2017). Purpose: The purpose of this capstone project was to answer the clinical question, “How does the implementation of an advance directive/advance care planning protocol in a primary care office impact the completion rates of advance directives?” Methods: This capstone project implemented an evidence-based practice intervention regarding advance care planning (ACP) in a primary care clinic. The project followed a descriptive quality process improvement design. The significance of the project outcome was determined by a hypothesis test based off of quantitative data collected prior to and after the implementation of the capstone intervention. Results: Twenty-seven of the thirty-four pre-intervention patients, or approximately 79%, did not have any form of an AD and would have been appropriate candidates for the capstone intervention. Post-intervention data resulted in a total of twenty-eight patient chart audits. Fifteen or approximately 54% of the post-intervention population did not have any form of an AD. Out of the fifteen patients that did not have an AD, fourteen individuals were deemed appropriate candidates for the capstone intervention. After receiving information regarding ACP, two individuals opted to promptly schedule an appointment for ACP, eleven reported they would be scheduling an appointment at a later date, and one individual declined AD education and ACP options. A hypothesis test was conducted to determine the effect of the capstone interventions and concluded the findings were statistically significant. Conclusion: A significantly higher proportion of patients were interested in ACP due to the effect of the capstone intervention as compared to the proportion that could be expected to be interested due to chance alone. This capstone project successfully evaluated the efficacy of an AD protocol in the primary care setting in relation to patients’ readiness for ACP and ultimately AD completion.

Author Details

Alexei Boettcher, DNPc BSN, RN

Sigma Membership

Non-member

Lead Author Affiliation

Nebraska Methodist College, Omaha, Nebraska, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

Quantitative Research

Keywords:

Advance Care Planning, Advance Directive, Primary Care Provider, End-of-life Planning, Living Will, Power of Attorney

Advisor

Applequist, Hilary

Degree

DNP

Degree Grantor

Nebraska Methodist College

Degree Year

2019

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

Faculty Approved: Degree-based Submission

Acquisition

Self-submission

Full Text of Presentation

wf_yes

Download

Share

COinS