Proactive Advance Care Planning in Rural Primary Care

Abstract

Relying on a family member to make medical decisions on behalf of a person who is unable to speak for themselves can cause unnecessary stress, cost, and dissatisfaction for both patients and their family. Making decisions without knowing a person’s preference for care often leads to a poorer quality of life and discordant care. Without an advance directive to guide care, family members are left to assume the patient’s wishes which can cause them to second guess a decision. Lack of knowledge and understanding are among the top reasons for not completing advance directives. As part of routine check-ups or well visits, primary care providers have the responsibility to introduce advance care planning to patients while patients are of sound mind and continue this discussion to include caregivers and/or family members. This quality improvement project helped facilitate a new process for beginning the advance care planning conversation in one rural Midwest primary care clinic. Current practices were identified to develop methods for change followed by an eight- week period where educational materials were offered to patients being seen for wellness visits which allowed the provider an opportunity to introduce advance care planning. Ancillary staff helped identify patients meeting inclusion criteria and facilitate a post-educational handout regarding patient satisfaction that was used to measure outcomes of implementing a standardized process. Keywords: advance care planning, rural communities, primary care