Text

theses

Advance care planning (ACP) enables and empowers individuals to drive their medical care, especially once they become incapacitated by disease or terminal illness. Advance directives (ADs) have proven to decrease end-of-life expenditures by Medicare. In addition, completion of an AD increases the probability of medical care that coincides with the patient’s wishes and decreases decision-making burden for the family and physicians.

Purpose
The purpose of this quality improvement project is to assess the effectiveness in increasing advance directive completion rates by offering an educational intervention for healthcare providers about advance care planning.

Methodology
This quality improvement project was designed with implementation of a pre- and post-test survey design to measure healthcare provider knowledge on proper ACP approaches. Thirty healthcare providers (internal medicine residents and advanced nurse practitioners) that rotate through the medical/surgical pulmonary stepdown unit (PSDU) were offered education on advance care planning utilizing conversation guides and a presentation developed by the head of palliative care at Johns Hopkins Hospital. The number of ADs on file in the PSDU pre-implementation and post-implementation was evaluated by counting the number of ADs on file 3 months prior to implementation compared to the number of ADs on file over a 3-month period after implementation.

Results
A paired-samples t-test was used to compare the pre- and post-test survey results in order to determine the association between reinforced healthcare education and AD completion over a 6-month period. The findings revealed a statistically significant difference in the pre- and post-test scores, with an overall increase in scores post educational sessions. The paired-samples t-test indicated that scores were significantly higher post-implementation (M = 39.5, SD = 7.5) than pre-implementation (M = 30.5, SD = 5.8), t(29) = -6.8, p < .05, d = 1.34. According to the Chi-squared test, there was no association between reinforced education and AD completion rates (Chi-square = .029, p = .865), which is a reflection of the limited number of cases used for data extraction. The number of completed ADs on file post implementation increased from 6 to 15.

Implications for Practice
Based on the findings of this project, interventions to inform healthcare providers about the ACP process should be considered as part of clinical practice. It is strongly suggested that healthcare providers receive periodic updates regarding the ACP process in addition to receiving conversation tools for guidance. If the findings of this intervention could be applied to the overall hospital population, then this simple intervention would likely result in a significant increase in completed ADs overall. Thus, the objective of providing medical care that coincides with ones’ wishes and improved outcomes at the end of life would be a closer reality.

ETD_10734

DNP

Includes bibliographical references

doi:10.7282/t3-bctd-9s53

ETD doctoral

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