Date of Award

Spring 5-27-2017

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Lucia Gonzales, PhD, MSN, MBA, NP-C

Second Advisor

Kathy James, DNSc



Purpose: Advance Directives (AD) ensure that patients receive care consistent with their individual values, while also minimizing the decisional burden often placed on families when a patient’s wishes are not documented at the end of their life. This quality improvement (QI) project was intended to improve patients’ overall understanding of Advance directives (AD) and improve completion rates in a primary care setting for patients eighty years and above using a multimodal system.

Methods: This QI project occurred in a primary care setting from March 2016 through March 2017. The multi-modal approach used included contacting patients by telephone, mailing AD informational packets prior to scheduled visit, in office AD discussions and follow-up phone calls. Collected data included patients’ age, provider, status of AD completion, multi-modal approach used and patients’ availability for discussion. Patients included were eighty and above and did not have a documented AD.

Results: Pre-implementation, two participating providers had a 23.81% & 20.0% AD completion rate for patients eighty and above. Post-implementation, participating providers increased to 60.71% and 38.71% respectively.

Conclusions: A multi-modal approach with structured education on the topic of ADs and providers’ recognition of patients in need of ADs, resulted in improved rates of AD completion, while also facilitating patient centered care.

Keywords: Advance Care Planning, Advance Directives, End-of-life discussion

SQUIRE Guidelines .pdf (1014 kB)
Guideline used to format manuscript

Included in

Nursing Commons