Abstract
Introduction Patients with chronic heart failure face a life-limiting disease trajectory, yet many have not addressed end-of-life planning. The ideal method to assist patients with advance directive (AD) completion and end-of-life goal setting is not clearly established. Hypothesis: A nurse practitioner led, interactive education program for patients hospitalized with acute decompensated heart failure utilizing the Institute of Healthcare Improvement tool, The Conversation Project, will improve patient attitudes regarding advance directives, increase completion of advance directive documents and increase discussion of end-of-life goals with significant others and health care providers. Methods A convenience sample of 30 patients hospitalized with acute decompensated heart failure who had not completed AD was used. Study participants completed the Advance Directive Attitude Survey (ADAS) prior to reviewing The Conversation Project materials and receiving education from a nurse practitioner trained in end-of-life counseling. A comparison of pre-/post-intervention outcome measures included ADAS scores, completion of AD, establishment of surrogate decision maker and discussion of end-of-life goals with provider and significant others. Results All study participants (n=30) had positive ADAS scores prior to the intervention. Post intervention outcomes were measured 30 days after the intervention in 25 participants (83%). ADAS scores remained positive with no significant change (p=0.53). A noteworthy 64% (n=16) of participants discussed AD with significant other, 40% (n=10) established surrogate decision maker and 28% (n=7) completed AD. Only 12% (n=3) discussed AD with a health care provider. Conclusions A nurse practitioner led advance care planning program using The Conversation Project showed clinically significant, but limited outcome improvement. A positive attitude regarding AD was not associated with completion of AD documents or discussion of end-of-life goals with significant others or health care providers. Further study of measures to improve the AD completion process, including programs targeting the outpatient population over a longer time frame and strategies to increase discussion with health care providers is recommended.
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