Advance Care Planning Education Research Articles

Summary of evidence to facilitate the implementation of advance care planning among advanced cancer patients.

Advance care planning (ACP) is designed to ensure that patients lacking autonomous decision-making capacity receive medical services in accordance with their expectations and preferences. Individuals with advanced cancer are a crucial target for ACP implementation. However, the current practice of ACP in this group in China is suboptimal, demanding high-quality implementation evidence to strengthen ACP in the clinical practice of patients with advanced cancer. The existing literature can be summarized into 27 pieces of evidence across 7 dimensions, including initiation time, intervention content, intervention providers, intervention modalities, communication skills, outcome indicators, and environmental support. The aforementioned evidence could provide crucial support for improving ACP implementation for patients with advanced cancer. Subsequent research efforts should integrate patient preferences and explore the most suitable implementation strategies for ACP in the Chinese population with advanced cancer, considering diverse aspects such as traditional culture, ACP education and training, legislative support, and healthcare system refinement.

SERVICE PROVIDER PERSPECTIVES ON ADVANCE CARE PLANNING USE IN RURAL DEMENTIA PATIENTS AND CAREGIVERS

Abstract Compared to urban areas, advance care planning (ACP) utilization remains very limited in rural communities. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering well-documented benefits of ACP in improving quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. Moreover, research on factors affecting ACP use among PWD has been primarily based in metropolitan/urban areas. To address the knowledge gap, this study aimed to explore barriers and current resources for ACP of PWD from perspectives of health and social service providers in rural Alabama. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 10 health and social service professionals serving older adults and their caregivers in rural communities of Alabama. Thematic analysis was used to find recurrent themes and patterns from transcribed interview data. Our analysis revealed four areas of barriers to rural PWD’s ACP: (1) PWD’s and caregivers’ lack of knowledge about ACP, dementia, EOL care options, and available resources, (2) misconceptions of completing formal documentations, (3) emotional barriers, and (4) limited access to existing resources. Elder law clinic and local Area Agencies on Aging were the most prominent, existing resources for ACP in rural Alabama. Participants also showed a type of misconception that a lawyer and/or a notary is required for ACP. The study highlighted an urgent need for social policy in ACP education for both caregivers and service providers in rural settings.

The Effectiveness of Advance Care Planning (ACP) Training for Care Home Staff: An Updated Systematic Review

Context: Population ageing and projections that more people will die in care homes demand that care home staff are prepared for advance care planning (ACP). This is an update of a prior review, published in 2021, of ACP education interventions for healthcare professionals in care homes. Objective: We sought to address the questions: (1) What ACP education interventions exist for care home staff? and (2) How effective are these interventions? Method: The review adheres to PRISMA; PROSPERO (ID: CRD42022337865). Original research evaluating ACP education for care home staff, reporting any measurable outcome of effectiveness, was included. Extensive literature searches were performed from March 2018 to June 2022. The results were reported by narrative synthesis. Findings: We identified 10 studies (310 care homes), from the UK, Belgium, Norway and Canada. Major sources of heterogeneity between studies include intervention design, target population and outcome measure. More recent interventions target the wider multi-disciplinary team. There is a trend towards the adoption of more resident/family and staff-related outcomes. There was insufficient evidence to draw conclusions about the effectiveness of ACP education interventions. Limitations: Heterogeneity of the primary studies did not allow for meta-analysis. Implications: There is still insufficient data to determine the effectiveness of ACP education interventions for care home staff. Future researchers should aim to agree on outcomes that are specific to ACP education interventions for care home staff and develop standardised, validated outcome measures. Study design should consider an intervention’s ‘theory of change’ when considering outcomes.

Implementation of advance care planning quality initiative in community cancer center.

422 Background: Advance Care Planning (ACP) is an integral part of the journey of a cancer patient. Our goal was to increase awareness, normalize conversations, and improve documentation of Advance Care Planning needs in Oncology Patients. Methods: 2021 Q4: Identified MIPS 047 Advance Care Planning and PIMSH1 Advance Care Planning in Stage 4 disease as an opportunity to improve ACP. Forms updated to include ACP information on New Patient Paperwork, including a Consent to Communicate, which included detailed information on Surrogate Decision Maker designation. Q1: Letter to the patient was added to New Patient Packet with information on Advance Directive (AD) and POLST for all patients. Standardized the use of Oregon Health Authority AD and User Guide, available in multiple languages. Q2: Educated Front Desk staff to include screening for Surrogate Decision Maker. Educated MA team on screening for ACP needs, appropriate documentation in EHR and State POLST Registry, and on appropriate follow up for patients requesting ACP counseling Q3: The US Oncology Network provided a Difficult Conversations Workshop and ACP training with Support Services Team, including Patient Navigation Team and Social Workers. Social Workers provided ACP visits. Q4: Standardized Nurse Navigator visits to include ACP needs and resources at C1D1 education or when referred. 2023: Changes to workflow are on-going and fine tuning occurs with review of metrics and a Continuous Quality Process Improvement plan. Results: See table. Conclusions: MIPS 047 has risen from 42.8% in 2021 to 94.4% 2023 YTD, which includes patients 65 and older that have been screened for ACP needs, have designated a Surrogate Decision Maker, or have a copy of an AD or POLST on file in the EHR. This has increased from 21.8% to 77.6%. Early and often conversations around ACP has markedly increased ACP information and education for a large majority of our patients. This team-based approach has impacted increase in metrics and understanding.[Table: see text]

Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews

ObjectiveThe COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of...

Social workers' perspectives about advance directives: A qualitative study

ObjectivesThe study explores medical social workers’ perceptions on the importance of and purpose for documenting Advance Directives (ADs) in the United States and their views of the benefits for engaging patients and families in dialogue about ADs and Advance Care Planning (ACP). MethodsWe conducted a qualitative study using free-text responses from a survey of 142 social workers who work in the medical field in various in-patient hospital and out-patient medical/healthcare settings. Participants were asked, “What is the purpose of documenting an advance directive?” and “Why do you think advance directives are important?” and “What benefits have you experienced in educating patients about advance directives?” Thematic analysis informed themes about the purpose, importance, and benefits of supporting patients in completing an AD. ResultsFour themes emerged: 1) The purpose of documenting an AD, 2) Facilitating communication, 3) Creating a plan involves relationship building, and 4) Having an AD reduces suffering and uncertainty. ConclusionSocial workers have expertise in relationship building which is an essential element of the partnering process with patients and their support systems towards AD completion. Practice ImplicationsSocial workers who work in medical settings provide ACP education for patients and families and create interprofessional linkages to support patient care. It is clear that social workers add value to care provision to improve communication and provide assistance towards AD completion.

A model for community-led peer-facilitated advance care planning workshops for the public.

The core to successful advance care planning (ACP) facilitation is helping people determine their values, beliefs and wishes, and understand substitute decision-making. Recognizing the potential for community members to support public awareness and education we developed a model of ACP education, whereby peer facilitators associated with community organizations host workshops that educate and assist members of the public with ACP. Describe the development and evaluation of the model for community-led peer-facilitated ACP workshops for the public. Descriptive mixed methods. A training curriculum and program model were co-developed with two community organizations that had been successful in delivering ACP workshops independently in their communities. Herein we describe a mixed-methods evaluation of three cycles of implementation and improvement of the model. The model centers on three key concepts; the right content (based around three steps Think, Talk, Plan), the right facilitator, and the right approach. A suite of tools was designed to support the three groups involved in the delivery of the ACP workshops: the public participants, the peer facilitators, and the community-based organizations. The peer-facilitator training addresses the facilitator's learning needs of ACP content knowledge, facilitation skills, and understanding change behavior. Training evaluation data from 106 facilitators confirmed that the curriculum prepared them to facilitate the workshops. Qualitative data revealed that support from organizations with established reputations in their community is critical, with mentoring from more experienced facilitators beneficial. Our model demonstrates the potential of community-led, peer-facilitated ACP initiatives to enhance the capacity of community to upstream ACP conversations. Reaching a broader audience and creating a supportive, inclusive environment for individuals to comfortably learn about ACP can drive the much-needed culture shift to normalize ACP. Meaningful community engagement, empowerment, and partnerships are essential for the successful development and widespread impact of these initiatives.

Expansion of an advance care planning initiative in patients with metastatic cancer: Successes and challenges.

197 Background: Advance Care Planning (ACP) activities including dialogs about care preferences, patient goals, and advance directives are an important component of cancer care. A pilot ACP initiative has been expanded to include additional sites of cancer care within the Cedars-Sinai Cancer Health System. Methods: The pilot study including two cancer care sites (started July 2017) was expanded to include two additional sites. The prior results were presented to 86 oncologists at all four cancer care sites to promote increased ACP activities for patients with metastatic cancer and/or refer those patients to palliative medicine (PM). ACP activities were defined as one of the following within the last year: 1) an advance directive (AD) or physician’s order for life sustaining therapy (POLST), 2) an ACP note and/or 3) a PM referral. Patients with metastatic cancer were identified by an EMR M1 designation by the oncologist from July 2021 to March 2022. Oncologists received monthly lists of patients with metastatic disease lacking ACP activities and quarterly scorecards with their ACP completion rate compared to their peers. Results: An average of 1302 unique patients with metastatic cancer were identified each month combined from all four sites. System wide ACP activities were unchanged from a baseline 51% in July 2021 to 53% in March 2022. One site representing, an average of 101 patients/month, increased ACP activities from 16% to 65%. Conclusions: This initiative increased ACP activities since July 2021 for patients with metastatic cancer at one of four sites. The remaining three sites, two of which were part of the pilot from 2017, showed a plateauing of ACP activities despite embedded PM providers, ACP education and monthly feedback to the providers. This may have been from a higher baseline and longer PM presence at those sites. The site showing improvement was given economic incentives to meet Cedars-Sinai priorities for ACP activities and started at a lower baseline, both of which may have contributed to the increase. Further improvement in ACP activities may occur with involvement of clinic reception, nursing and social work along with more broad economic incentive for ACP activities. This increase was primarily from ACP note completion of 53% (PM 18% and AD completion 10%).[Table: see text]

Sustainability of a Multifaceted Intervention to Improve Surrogate Decision Maker Documentation for Hospitalized Adults.

Documenting surrogate decision makers (SDMs) is an important step in advance care planning (ACP) for hospitalized adults. The authors performed a quality improvement study of clinical and electronic health record (EHR) workflows aiming to increase SDM documentation for hospitalized adults. The intervention included an ACP education module, audit and feedback, as well as workflow and EHR adaptations. The authors prospectively tracked SDM documentation using control charts and used chart review to assess secondary outcome, process, and balancing measures. SDM documentation significantly increased from 69.5% to 80.2% ( P < 0.001) for intervention patients, sustained over 3 years, and was unchanged for control patients (34.6% to 36.3%; P = 0.355). There were no significant differences in secondary ACP outcomes in intervention or control patients. Clinical and EHR adaptations increased SDM documentation for hospitalized adults with minimal risk, although did not affect other ACP metrics. Future studies are needed to determine the effects of such changes on goal-concordant care.

Identifying barriers to advance care plan completion among older adults

Advance care planning (ACP) is an important tool for preserving patient autonomy and benefits patients, families, and providers. ACP is underutilized throughout the United States, yet the factors contributing to this deficit are poorly understood. The purpose of this study was to develop an understanding of older individuals’ attitudes towards advance care planning and to characterize perceived barriers to ACP completion. A sample of 240 United States residents age 65-years and older were invited to complete a survey assessing their attitudes toward ACP through an online panel. Participants were administered a structured questionnaire comprised of scaled items that were derived from prior qualitative discussions about ACP with groups of seniors. An analysis of Likert scale responses was performed to identify common barriers underlying participants’ reluctance to complete advance care plans. One hundred and thirty (54%) respondents reported having completed an advance care plan, while 110 (46%) had not. Those who completed ACPs feel it is important to avoid burdening their families with difficult decisions and healthcare expenses by stating their preferences, a finding that is consistent with prior research. Among those without advance care plans, 53 (48%) reported they had heard of advance care planning before participating in the study. The most prevalent barriers were uncertainty about healthcare preferences and uncertainty about how to initiate advance care planning. External barriers such as inconvenience, time, and cost did not emerge as important barriers. Free-text responses provided additional context to respondents’ answers. The relatively low rates of advance care plan completion and awareness among older Americans illustrate a pressing need to expand ACP education. Additionally, participants’ responses indicate that a set of internal barriers inhibit older individuals from completing advance care plans. Understanding these barriers can guide patient-centered discussions of advance care planning across multiple clinical settings and inform community efforts to improve ACP access. In particular, helping patients formulate and articulate their healthcare preferences may help increase ACP uptake.

Advance Care Planning and Communication Skills Improve after an Interprofessional Team Simulation with Standardized Patients.

Background:Improving rates of advance care planning (ACP) and advance directive completion is a recognized goal of health care in the United States. No prior study has examined the efficacy of standardized patient (SP)-based student interprofessional ACP trainings.Objectives:The present study aims to evaluate an interprofessional approach to ACP education using SP encounters.Design:We designed a pre–post evaluation of an innovative interprofessional ACP training curriculum using multimodal adult learning techniques to test the effects of completing ACP discussions with SPs. Three surveys (pre-training T1, post-training T2, and post-clinical encounter T3) evaluated student knowledge, Communication Self-Efficacy (CSES), ACP self-efficacy, and interprofessional teamwork (using SPICE-R2).Setting/Subjects:Students from the schools of medicine, nursing, and social work attended three training modules and two SP encounters focused on ACP.Measurements/Results:During academic year 2018–2019, 36 students participated in the training at University of Maryland. Results demonstrated statistically significant improvements in ACP self-efficacy, MT1 = 2.9 (standard deviation [SD]T1 = 0.61) compared with MT3 = 3.9 (SDT3 = 0.51), p < 0.001, and CSES, MT1 = 4.6 (SDT1 = 1.35) versus MT3 = 7.3 (SDT3 = 0.51), p < 0.001, from T1 to T3. There was a medium-to-large improvement in knowledge from an average score of 4.3 (SD = 1.0) at T1 to an average score of 5.5 (SD = 1.4) at T2, p = 0.005, d = 0.67.Conclusions:Our interprofessional training module and SP encounter was successful in improving medical, social work, and nursing students' self-reported communication skills and knowledge regarding ACP.

"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.

Part of the solution: A survey of community organisation perspectives on barriers and facilitating actions to Advance Care Planning in British Columbia, Canada.

BackgroundDespite the established benefits of Advance Care Planning (ACP), engagement remains low in British Columbia. Since 2016, a growing number of community‐based nonprofits have offered ACP education. To date, no study has focused on the perspectives of nonprofits on ACP in British Columbia.ObjectiveThis study aimed to identify barriers and facilitating actions to ACP as perceived by British Columbian nonprofits.DesignA mixed‐methods design was used. Data were collected through online surveys and telephone interviews.Setting and ParticipantsStaff and volunteers from British Columbian nonprofits that are providing or interested in providing public education on ACP were recruited for this study.ResultsThe lack of public awareness of ACP, the emotional difficulty of the conversation, the complicated ACP process, the belief that ACP is synonymous with completing a medical order form, the challenge of introducing ACP in different cultural contexts and the siloed approach to ACP education were rated as the most important barriers to ACP engagement. The most important facilitating actions were developing clear messages, improving ACP literacy, reframing ACP as part of life planning, simplifying ACP documentation and transfer, integrating ACP conversations into clinical practice and better collaboration between the health system and nonprofits.DiscussionThis study identifies numerous opportunities to improve ACP engagement in British Columbia from a community lens. To maximize ACP engagement, community‐led ACP education should be offered in coordination with the health system.ConclusionCommunity‐led ACP education as well as collaboration and consultation with nonprofits are part of the solution to the low ACP engagement in British Columbia.Public ContributionStudy participants, including staff and volunteers at nonprofits, are members of the public.

Let’s Talk About ACP Pilot Study: A Culturally-Responsive Approach to Advance Care Planning Education in African-American Communities

The COVID-19 Pandemic has emphasized the importance of attending to racial inequity in end-of-life care, as the world has witnessed the disproportionate negative impact on Black and Brown people and communities. Advance care planning (ACP) is of particular concern for this population. This article introduces an ACP toolkit developed as a culturally responsive educational approach to assist African-American faith leaders to inform and educate congregants on end-of-life care options and the process to complete advance care documents. The purpose of this article is to describe the development of The Let’s Talk about ACP toolkit and to discuss the results of the pilot study workshop. The procedures of the pilot study included a critical evaluation of an innovative curriculum and workshop process for engaging African Americans around advocacy for the healthcare experience they prefer. Factors such as cultural, generational, and spiritual beliefs and values influenced decision-making. Distrust was one of the most prominent factors raised by participants. Providing resources and tools that encompass culturally responsive approaches to educate and encourage use can help bridge the gap. The next steps for this innovative practice approach is to refine the practice approach and replicate the finding among larger community settings.

Knowledge, attitude and practice of advance care planning among nursing interns: A mixed-methods approach

AimTo investigate the knowledge, attitudes and practice of advance care planning and confirm their influencing factors among nursing interns in China. BackgroundDue to a lack of standardized courses on advance care planning (ACP) in China, nursing interns do not possess the knowledge of ACP and cannot apply it to clinical practice. DesignA convergent parallel mixed-methods design. Methods382 nursing interns aged > 18 years were recruited using convenience sampling. Quantitative data were collected using the General Demographic Characteristics Questionnaire and the Advance Care Planning Knowledge, Attitude and Practice Questionnaire. Thirteen nursing interns were drawn from the quantitative phase and their interviews were thematically analyzed. Results: The ACP attitudes and practice scores of nursing students were 48.85 ± 6.39 and 32.23 ± 4.58, respectively, with a high level, while their ACP knowledge score was 6.89 ± 2.70, with a medium level. The significant promotive factors included positive attitude toward death and the nursing major and experience in clinical rescues and palliative care training; The key hindrance factors included the lack of ACP education and the limitations of the working environment. ConclusionsThe study highlighted the importance of delivering systematic palliative care training and integrating the practice of ACP into routine nursing practice. Doing this can help expand advance care planning knowledge, establish positive attitudes and meet the practical needs of nursing interns for their ACP clinical practice.

Evaluation of a Large Scale Advance Care Planning Co-Design Education Program for Chinese-Speaking People in Australia

Advance care planning (ACP) is important, however ethnic minorities have half the completion rates in the United States compared to Caucasian counterparts, and in Australia only 3.5% of advance directives were completed by those overseas-born.Educational intervention improves ACP knowledge and subsequent uptake. We evaluated immediate and longer-term outcomes of a co-designed ACP education toolkit in Chinese-speaking people in Victoria, Australia. We conducted a cross-sectional survey of Chinese-speaking community members who participated in a co-designed Chinese ACP educational workshop. A self-selected subgroup were subsequently contacted 6 months later to determine longer-term outcomes. Of 519 attendees across 17 workshops, 325 (63%) completed the evaluation. The majority (63%;n = 206) were previously unaware of ACP. Perception of receipt of useful information positively correlated with motivation to undertake ACP (r = 0.3486, p < 0.001). Of the 70 participants who consented to follow up, 36% (n = 26) agreed to participate in structured telephone interviews. English speakers were more likely to have undertaken ACP (n = 6 vs n = 3). ACP completion was not associated with being a carer or suffering from cancer or chronic illness. This first Australian study evaluating ACP co-design education implementation outcomes in Chinese-speaking people supports that motivation to undertake ACP is related to knowledge,albeit a modest ACP uptake in a small follow up sample. Clinicians should note that this assists with ACP uptake, with likely downstream improved health outcomes. This co-designed toolkit could be helpful in increasing ACP uptake. Future engagement by Chinese language societies to overcome further barriers to ACP is needed.

'The Woman Gives': Exploring gender and relationship factors in HIV advance care planning among African American caregivers.

Advance care planning (ACP) is the communication process of documenting future healthcare preferences in case patients are unable to make healthcare decisions for themselves. Research suggests ACP discussions among persons living with HIV (PLHIV) are infrequent overall and may differ by gender and/or race. Previous literature has displayed that African Americans are less likely than other racial groups to use advanced care planning, palliative care or hospice, but does not conclusively account for ACP among PLHIV. African American PLHIV rely on informal care that may be differ by gender and represents an important pathway to increase ACP. The study was mixed methods and observational. Participants completed self-report surveys (N=311) and were interviewed (n=11). Poisson regression (quantitative) and grounded theory analyses (qualitative) were implemented, using COREQ checklist principles to ensure study rigor. Less than half had discussed ACP (41.2%; N=267). More ACP knowledge predicted 76% lower likelihood of ACP discussions among women. Men who spent more time caregiving in a given week were nearly 3 times more likely to discuss ACP than men who spent less time caregiving. Women were more likely than men to be caregivers and were also expected to serve in that role more than men, which was qualitatively described as 'being a woman'. The present study is one of few studies exploring ACP among caregivers in African American populations hardest hit by HIV. Results suggest that ACP skill building and education are critical for African Americans living with HIV to promote ACP discussions with their caregivers. Knowledge about ACP topics was low overall even when healthcare had recently been accessed. Support reciprocity and gender-specific communication skill building may facilitate ACP in African American HIV informal caregiving relationships. Results underscore the need for ACP education which includes healthcare providers and caregivers, given African Americans' preference for life-sustaining treatments at end-of-life. ACP is crucial now more than ever, as COVID-19 complicates care for older adults with HIV at high risk of complications.

Benefit, Barrier, and Self-Efficacy Messages in Advance Care Planning Education Materials

ABSTRACT Advance care planning patient education materials are informational tools intended to empower patients to engage in preventative behaviors relevant to end-of-life decision-making. Fewer than 30% of patients engage in advance care planning (ACP) and little is known about specific messages relevant to health behavior change in ACP education materials. Using the Health Belief Model as a framework, this study used content analysis to examine both manifest and latent message content in ACP education materials (N = 58), focusing specifically on benefit, barrier, and self-efficacy messages. Results indicated that education materials lack unique, specific benefit, barrier, and self-efficacy messages, which may lower patients’ motivation and self-efficacy with regard to ACP. Based on these findings, recommendations for designing ACP education materials in medical organizations are made.

Nurse Practitioner-Led Education: Improving Advance Care Planning in the Skilled Nursing Facility

The Advance Care Planning (ACP) note is a critical component for guiding the care of patients in the Skilled Nursing Facility (SNF). Although ACP documentation is essential, it often is not completed in the SNF. The purpose of the project was to increase the number of ACP notes for patients admitted to 13 SNFs in Southeastern Minnesota. Prior to intervention, the ACP note was not consistently completed by the Nurse Practitioner (NP) or Physician Assistant (PA) in the SNF. The aim of the Quality Improvement (QI) project was to increase ACP note completion rates by 50% and increase satisfaction and knowledge with the ACP process amongst NPs and PAs over a 12-week period after the administration of a one-hour ACP education session. By improving the ACP process, patients can participate in a positive end-of-life experience and receive medical care that is consistent with their values, goals and preferences. The hypothesis for this project was that a structured ACP process would increase the number of ACP notes completed compared to current processes. A secondary outcome was that structured ACP process would increase NP and PA satisfaction and knowledge with completing ACP notes. The design was a QI project that addressed the ACP process in 13 SNFs in Southeastern Minnesota. A convenience sample (N=10) of NP/PA providers completed a pre and post ACP education intervention survey. On all six survey questions, a general increase in mean value was demonstrated. Question two, seven and eight demonstrated the greatest increase in mean value score of (0.7, 1.2, and 0.9) respectively. A Wilcoxon signed-rank test elicited significant change in knowledge (p=0.037), understanding of ACP note billing (p ≤ 0.001), and satisfaction with ACP note documentation (p=0.004). Unfortunately, the QI project demonstrated a 2% decrease in ACP note documentation in the post-intervention phase. Although there was not a significant change in the ACP note completion rates, an improvement in NP/PA knowledge and satisfaction was demonstrated through ACP education session.

Advance Care Planning: A Three-Phase Community Initiative, Educating Clinicians and Engaging Employers in NY’s Capital District

Abstract Advance Care Planning (ACP) emphasizes the process of communication necessary to assist individuals in making informed decisions about their future medical care. In response to the Institute of Medicine’s (IOM) call for enriching preparation of Advance Directives (AD) in their Dying in America consensus report of 2014, this author developed, designed and initiated a three-phase program to heighten awareness of ACP in New York’s Capital Region. Phase I, Community Conversations, is directed toward healthy individuals who are upstream from illness. Individuals in faith-based groups and civic organizations are provided tools and resources to prepare their own Healthcare Proxies, Living Wills and conduct important conversations with their loved ones about honoring their wishes and goals. Phase II, Advancing ACP Education in Medical Practices, is a structured training program for clinical professionals who receive certification as ACP facilitators and conduct ACP activities with their patients including conversations about what matters most and preparation of ADs for their medical records. Phase III, Advance Care Planning Education Through Employers, is a program which reaches people in their workplace. The purpose of this phase is twofold: to meet the needs of individuals who might not be otherwise exposed to ACP information, and to engage employers who sustain the important preparation of ADs through their human resources departments. A blueprint for each phase was designed for replication in other communities. Over a five-year period, and phase implementation, the program has been recognized as a premier resource for Advance Care Planning outreach. The project demonstrates the initiative, scope and activities that have far-reaching implications for the preparedness and health of an aging community. This review represents key elements and discovery with respect to all three phases of the project.