Promoting Advance Care Planning in Primary Care: A Pilot Study on the Impact of Clinician Education and Workflow Development

Although evidence supports the efficacy of advance care planning (ACP) in improving quality of care and the overall well-being of patients and families, there are many barriers to engagement in this process. Fortunately, clinician and patient education and workflow development in primary care settings have shown promise in their ability to overcome these obstacles to improve awareness of and engagement with the ACP process as part of preventative care. The purpose of this project was to apply current research on this topic to improve patient engagement with ACP in the primary care setting using the Iowa Model of evidence-based practice. The interventions utilized in this project included a brief multimodal educational session for clinical staff, distribution of patient education materials, and development of a streamlined workflow to provide guidance to adult patients on ACP and document the provision of this education and the completion of advance directives. Ultimately, the clinician educational session was effective in increasing clinician knowledge on ACP and confidence in providing education to patients on the topic. The combined interventions had a clinically and statistically significant impact on providers’ rate of documentation of the provision of ACP education, particularly for adults aged 50 and older. There was insufficient evidence that the interventions resulted in an increase in the percentage of patients with an advance directive on their medical record. The results of this project support the efficacy of interventions involving education and workflow development to increase engagement with ACP in the primary care setting, consistent with the current literature. This project provides a replicable model for an evidence-based practice initiative to promote ACP with adult patients in the primary care setting.