Advance Directives in Primary Care: Increasing Patient Engagement through Community Outreach.

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this project was to demonstrate the efficacy of an hour-long educational, interactive seminar to increase participant readiness and engagement in advance care planning activities in the Benson, Arizona community.Background: Advance care planning is the process of identifying values, preferences and goals of healthcare decisions, in the event an individual is unable to make the choice for themselves. Advance directives provide a means to document these decisions in a legally meaningful way but only about one-third of adult Americans report having completed an advance directive. Research has shown that outcomes may be negatively impacted in the absence of advance care planning, especially in cases of critical illness or end-of-life. The providers affiliated with Benson Hospital have recently undergone training to promote advanced care planning in their practice, but the research has demonstrated that multi-modal interventions have been more successful in promoting advanced care planning engagement than any single intervention alone.Methods: This project utilized pre- and post-intervention survey data to demonstrate the change in advance care planning engagement utilizing the Advance Care Planning Engagement Survey, a validated survey tool that utilizes four Likert-type questions. Results were then statistically analyzed using frequencies and Wilcoxon signed-rank test to determine statistical significance.Results: Fifteen adults participated in the seminar and completed the pre-post survey which demonstrated an overall increase in participant engagement in advance care planning activities. One-third of the participants reported already completing advance care planning documentation prior to the seminar, consistent with the national average. Survey results demonstrated a marked increase in median engagement in advance care planning activities, although the p-values were greater than 0.05 and thus not statistically significant.Conclusion: The survey results for this project did not demonstrate statistically significant changes, however participant responses were generally positive showing increased engagement in advance care planning activities. Future projects should focus on recruiting larger sample sizes, measuring advance directive completion rates and the effect of advance directive documentation on care outcomes.