Increasing Advance Care Planning Among Older Adults and At-Risk Patients in the Outpatient Setting

Background: Advance care planning (ACP) is crucial for patients to clarify end-of-life wishes and avoid unnecessary treatment, yet discussion rates remain low in primary care. Addressing ACP early, such as in primary care, allows patients to make clear end-of-life choices for themselves. This DNP project aimed to increase ACP among older adults and individuals at risk for health decline, in an outpatient setting, through an evidence-based educational intervention for patients and providers. Methods: This project implemented an educational intervention for patients and providers at this office: Five Wishes and an in-person discussion for participants and providers at a primary care clinic. Data was collected from pre-/ post-questionnaires completed by participants. Descriptive and non-parametric statistics were used for data analysis. Results: The evidence-based educational intervention, Five Wishes, significantly improved both ACP readiness as well as and understanding of ACP in pre-/post-survey results. Twenty-nine percent of patients completed an advance directive after the intervention. Frequent verbalized comments noted during the discussion revealed that some participants weren’t emotionally open to ACP and were only familiar with it due to the death of a relative, which could lead to a potential emotional barrier. Among participants, the patient population was elderly (60-79 years), and CCI scores demonstrated an increased risk for health decline. The provider participation was low, and survey results were unchanged post-intervention. Conclusion: The project’s objectives were successfully met, demonstrating that the educational intervention, Five Wishes, was effective in positively impacting behavior changes, notably readiness and understanding, regarding advance care planning among participants.