Implementation of an Advance Care Planning Protocol to Increase Advance Directive Completion Rates

Advanced directives (AD) allow an individual to retain autonomy in end-of-life decisions and can prevent unnecessary costs and treatments associated with aggressive life-prolonging measures. As of 2017, only an estimated 36.7% of the United States adult population had a form of advance directive documented (Yadav et al., 2017). The purpose of this evidence-based project was to determine if implementation of an advanced care planning (ACP) protocol would increase ACP discussions, AD completion, and result in a modification in stage of change or behavior. The Transtheoretical Model (TTM) and Stetler Model of evidence-based practice were used as the framework to guide project implementation at a non-profit clinic in Northwest Indiana. An ACP protocol was implemented based on an extensive review of the literature on adult patients 50 years and older who presented for wellness and annual exams. Providers and applicable staff were educated on their role in implementing the protocol. Over a 12-week period, qualified patients received an AD information folder when brought back to the exam room to review prior to seeing the provider. Nursing staff documented demographic information, obtained consent for follow-up, and placed a yellow algorithm worksheet at the providers’ computer desk to signal that ACP was to take place during the visit. Providers would then initiate ACP discussion by following the six question algorithm on ADs and quality versus quantity of life. Pre-intervention patient data and AD completion rates were collected by the facilities data analyst. Post-intervention data was collected by providers within the protocol worksheet and by the project leader upon follow-up phone calls. Data was found to be significant for an alpha of 0.05 when attempting to detect a significant degree of change in TTM behavior from pre to post of both ADs (p = .000) and quality versus quantity of life (p = .000). Providers engaged in ACP at a rate of 46%. ACP and AD completion rates increased from baseline values, with 4% of individuals creating and documenting an AD at the initial visit, and 45% of participants creating an AD following the ACP discussion