Implementation of Advanced Directives

Abstract

An advanced directive (AD) is a legal document that allows patients to specify their decisions for future care while they have the legal and physical autonomy to do so. The self-autonomy promoted by ADs is established in legislative policy through the Patient Self Determination Act (PSDA), which encourages patients to draft ADs while they are still competent. Despite the passage of PSDA, only 25% to 30% of Americans have completed an AD. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project is to develop and implement advanced directive (AD) policies and procedures and to implement a pilot project to enhance the rate of advanced care planning completion in patients 50 years of age or older at a primary care clinic that serves patients who are at or below the federal poverty level. The Health Belief Model (HBM) and The Plan Do Study Act (PDSA) were utilized to guide this project. The PREPARE tool was selected to help patients as they engaged in advanced care planning. The staff were trained to implement the selected tool. The forms were mailed to eligible participants along with a letter that provided information about the project. Participants were asked to contact the clinic at their earliest convenience to learn more about the project and schedule an appointment with a DNP student investigator if they agree to participate. A brief pre-visit survey was administered to gather data on knowledge and awareness about ADs. Thirteen out of 114 mailings received responses and those patients were scheduled for appointments. Of 13 eligible patients who were screened during pre-visit, nine continued to pilot-study. Five of the nine patients who participated in the pilot study completed ADs.