Abstract
Advance care planning (ACP) has been shown to have many benefits including improved communication and increased alignment of end-of-life care with patient wishes. Despite these benefits, many individuals have never discussed end-of-life preferences or receive care inconsistent with their wishes at the end-of-life. There are several barriers to ACP including lack of provider knowledge and training. In addition, many primary care providers report a knowledge gap, lack of confidence, and inadequate training in ACP. The overall purpose of this quality improvement project was to increase ACP conversation engagement among patients, providers, and staff in an internal medicine clinic. A multicomponent ACP intervention including an ACP checklist, patient ACP informational brochure, posters promoting ACP conversations, and provider education was implemented. Results suggest that 23% of patients in a primary care clinic were open to having an ACP conversation with their PCP, supporting the need for ACP in primary care. The use of an ACP checklist successfully prompted ACP discussions with 11 patients and plans for future discussions with 3 patients. The project also revealed a continued focus among providers and staff on AD completion and documents rather than emphasis on the meaningfulness of the conversation. Assessment of provider ACP self-efficacy revealed a relatively high level of ACP-self efficacy despite relatively low ACP engagement. More research into the relationship of ACP self-efficacy and ACP engagement is needed. The project and results were significantly limited by the Coronavirus Pandemic and continued study is needed to guide future recommendations and interventions.