Multimodal Intervention to Increase Advance Care Planning in Primary Care Medicare Patients

Abstract

Advance care planning is the guideline recommended process which encourages adults to analyze values, identify goals, and articulate preferences for future medical care in order to protect autonomy in the event of future medically associated incapacity. Unfortunately, many patients report never having participated in advance care planning due to numerous patient, provider, and systemic barriers. The purpose of this evidence-based practice project was to determine if pre-wellness visit multimodal education utilizing multi-media decision aids and group medical visits increased advance care planning among Medicare patients within a primary care setting. The intervention was evaluated using a randomized controlled trial. The project was facilitated in a primary care clinic located in Kansas City, Missouri with a sample of 22 Medicare patients. Medical record documentation of advanced care planning at the Medicare annual wellness visit was the primary study outcome. Changes in patient knowledge, self efficacy, and readiness to engage in advance care planning were secondary outcomes. No increase in documentation of advance care planning was noted following the intervention. Improvements in patient knowledge, self-efficacy, and readiness to engage in advance care planning were identified among all participants with statistically significant improvements in patient knowledge noted in the intervention arm participants. As society faces a rapidly aging population, identifying effective and ineffective methods of increasing advance care planning participation is vital to improving quality of care at the end-of life, safeguarding patient autonomy, and potentially reducing healthcare costs by preventing the delivery of undesired care.