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Doctor of Nursing Practice
Family Nurse Practioner
Year Degree Awarded
Month Degree Awarded
advanced directives, advance care planning, end of life, communication
Clare Lamontagne PhD, RN
DNP Project Chair
Clare Lamontagne PhD, RN
DNP Project Outside Member Name
Janice Peterson, DNP, FNP, BC
DNP Project Goal:The goal and expected outcome of this DNP project was to increase providers’ self-reported preparedness and comfort levels by 50% when discussing advance care planning (ACP) and end of life wishes with patients.
Background: The Institute of Medicine designed ACP as a national health priority. However, health care professionals often do not facilitate discussions of ACP with patients, even in patients with chronic or life-limiting illnesses. This occurs due to professionals’ lack of knowledge about ACP, lack of comfort when discussing the issue, and a misperception that the patient may be too young or not sick enough to discuss ACP. Earlier discussions may improve concordance between patient’s actual wishes versus the care they receive at the end of their lives. Training for health care professionals should focus on the importance of the issue, as well as specific communication strategies and tools to increase the frequency of discussions about ACP.
Methods: A quality improvement project was conducted for health care professionals (HCP) in Western Massachusetts. A one-and-a-half-hour educational session was held, which covered ACP basics, current gaps in practice, and communication strategies to facilitate discussions about ACP. Teaching was based on the Comskil educational model. HCP ratings of preparedness and comfort levels on discussing ACP were measured immediately before and after the intervention using a Likert-type survey.
Results/Outcomes:Participants rated their comfort and preparedness levels before and after the intervention. The before and after ratings were measured with descriptive statistics. Participants reported a higher level of preparedness (37% improvement) after the intervention. Participants also reported feeling mostly or very comfortable when considering ACP discussions with their patients (37% improvement). A communication tool was provided for participants, and 87% of participants felt they would use this communication tool in future discussions about ACP with their patients. Participants also reported that they were more likely to ask patients about ACP at every encounter (25% increase), and were more likely to start discussions about palliative care and hospice with appropriate patients (50% increase).
Implications for Practice:Health care professionals may benefit from educational sessions on advance care planning. Education should focus on the importance of the issue and communication strategies to make health care professionals more comfortable discussing these difficult topics. Ultimately, more training on this issue may lead to increased frequency of these conversations, and improved patient satisfaction with care as the population ages.
Conclusions: Conversations about ACP between patients and HCP do not happen as often as they should. Reasons for this include lack of comfort on the part of the provider, and inadequate communication skills training. This quality improvement project, which focused on training for HCP on this topic, showed that this education contributed to the HCP feeling more prepared to discuss these topics. Some providers may find a structured communication tool to be helpful in guiding these discussions. These communication tools can be individualized to the patient care situation. Improving communication about this topic will likely help to improve the quality of care that is provided to patients at the end of their lives.