Date of Award

Spring 5-27-2017

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard DNSc, CRNA


Purpose: The purpose of this evidence-based practice (EBP) project is to assess the effectiveness of a multimodal intervention to increase advance care planning discussions (ACP) and advance directive (AD) completion rates.

Background: Advance care planning (ACP) and advance directives (AD) is the ongoing discussion and recording of patient preferences and goals of care in the event they lose the capacity to speak for themselves. The Center of Disease Control and Prevention (CDC) estimates that 70% of Americans are without ADs. Centers for Medicare and Medicaid Services (CMS) reimburses for advance care planning consultations. ACP has improved multiple outcomes including higher rates of AD completion and patient satisfaction.

Project Process: Patients were identified based on AD completion status, age, and history of at least one chronic illness. These charts were flagged indicating the need for ACP and AD education and completion. Participants were mailed a letter of intent addressing the need for AD completion two weeks prior to their scheduled appointment with their primary care provider. A 30-minute face to face discussion focusing on ACP was conducted for each agreeable patient. Weekly follow up phone calls were conducted for patients unable to complete documentation during the encounter. The data collected measured AD completion and ACP discussions.

Outcomes: Interventions significantly improved completion of advance directives on average 23 AD ’s, from 55 to 78 (95% confidence Interval, 21, 34) and was statistically significant at p < .001. This was proven to be clinically significant improving completion of advanced directives by 20%.

Conclusions: Multimodal interventions have shown to increase completion rates. Through this evidence-based quality improvement project, providers will be encouraged to initiate and guide advance care planning discussions.

Included in

Nursing Commons