Title

Development of a Physician Resource Packet to Assist with Advance Care Planning in an Ambulatory Primary Care Setting

Document Type

Presentation

Publication Date

12-5-2013

Comments

Committee Chair: Nancy Chernett, MA, MPH, Thomas Jefferson University

Abstract

Advance Care Planning (ACP) involves a process of understanding, planning for, and interpreting complex, often difficult, healthcare choices based on personal preferences and values for future healthcare needs. ACP includes documentation in an advance directive (AD), designation of a healthcare decision-making proxy, and multiple conversations to understand and update the patient’s goals of care. Empirical data shows that patients want ACP conversations to be initiated by their healthcare provider prior to or in early stages of disease onset and in the primary care setting. Despite documented benefits of AD and ACP, AD completion rates range from 5-15% of the general population. Provider barriers to having ACP conversations have been identified as one factor associated with low rates of AD completion. The purpose of this study was to expand understanding of provider barriers to offering ACP in an ambulatory setting, and preferences for reducing those barriers. A focus group discussion was conducted with providers from a small primary care practice affiliated with an academic medical center in Philadelphia, PA to elaborate on provider ACP challenges and approaches to enhance ACP. Thematic analysis of the focus group data showed three main barriers to providers including time, physician logistical concerns, and discomfort. The overarching themes were broken down into sub-themes and approaches to reduce barriers. Data from the focus group, in conjunction with materials and methods from existing best practices, were used in the development of provider resources aimed at increasing and enhancing provider-patient ACP conversations. The resource materials will be reviewed by providers at the site designated to pilot their use. Results from this study also provide specific areas to target in future interventions at the patient, provider, and organizational levels.

Presentation: 27 minutes