Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor




Introduction: This evidence-based practice project aimed to provide an education program to Filipino Americans in their preferred language (English or Tagalog) to improve compliance with Advance Directive (AD) completion in a primary care setting. Educating them about AD empowers patients with their decision-making about their health in situations where they are incapacitated and unable to make sound decisions. Moreover, it will eliminate the decision-making problem for family members.

Background: An advance directive is a document that empowers patients to convey their wishes to their healthcare provider when they can no longer decide for themselves. Evidence suggested that AD completion was lower among Asian Americans (12%) than the US General population (26-36%). Most studies showed a lack of knowledge and awareness as deterrents. In addition, Asian ethnicities have specific socio-cultural, religious, and familial characteristics that can affect decision-making in healthcare. Advance directives can save an average of $673 in out-of-pocket costs and $100,000 less hospital expenses than those without AD.

Description of Practice Change: Adult Filipino patients from a primary care clinic who do not have AD were provided a 10-15-minute education in their preferred language (Tagalog or English) before a scheduled appointment. During the education session, patient’s ambiguity, concerns, and questions about AD were immediately addressed. In the initial approach, patients were given AD forms to take home written in their preferred language. They were expected to return the completed forms during the next scheduled appointment. A follow-up text or calls every 1-2 weeks were made to check progress or questions about completing the forms. This process proved to be unsuccessful. The improved approach was that the patients were asked to fill out the AD after receiving education, which proved successful.

Evaluation of Outcomes: Pre-education: Forty-one patients were screened in this project, and five patients already have AD. After AD education was rendered to the remaining patients, 6 patients completed the AD forms. Completion AD continued to be a challenge among Filipino-Americans. Further education in their preferred language about the importance of AD can improve patient compliance.

Keywords: Advance Directives, Filipinos, Asian American, Asian population.

Available for download on Friday, May 08, 2026

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