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Doctor of Nursing Practice
Family Nurse Practioner
Year Degree Awarded
Month Degree Awarded
Advanced Directives, Completion Rates, Primary Care, Healthcare Proxy, Medical Orders for Life Sustaining Treatment
Joan P Roche
DNP Project Chair
Joan P Roche
DNP Project Member Name
DNP Project Outside Member Name
Thomas G Salines
As technology has improved and the ability to artificially prolong life has increased dramatically, so has the need to draw attention to end-of-life care issues (Duke, Thompson, & Hastie, 2007). The Federal Patient Self-Determination Act (PSDA) of 1991 first brought attention to the importance of advance directives (ADs), (Government, 1995). Increasing the focus on advance directives for adult patients in the primary care setting could assist in increasing completion rates, prior to hospitalization.
The purpose of this project was to test a model to increase AD completion rates, to provide more complete patient centered care. Many programs and interventions have been implemented since the PSDA was enacted in 1992, some have been able to increase rates; other interventions have had little impact. It has been estimated that only 5%-15% of all patients have completed ADs (Ramsaroop & Adelman, 2007). This indicates a need for programs to educate and empower patients and providers to ensure ADs are completed.
An appropriate setting to complete advance directives is in the primary care setting due to the importance of having ADs prior to hospitalization. There are multiple reasons to support this setting for a focus on advance directives completion. These include the ability to develop a strong patient-provider rapport, the length of professional relationship and the ability to have multiple patient-provider interactions over time to discuss patient wishes and to potentially complete the AD during the interaction.