Project Five Wishes: promoting advance directives in primary care

Area of Science:

• Primary Care Medicine
• Health Services Research
• Patient Advocacy

Background:

• Advance care planning (ACP) and advance directives (ADs) have proven benefits, yet completion rates remain low (15-30% in US adults).
• Primary care settings are ideal for ACP, but face significant implementation barriers.
• A specific Northern Arizona primary care clinic reported very low AD rates (0.8%) among established patients.

Purpose of the Study:

• To increase the number of recorded advance directives (ADs) in a primary care setting.
• To evaluate the impact of a new intervention on AD completion rates.
• To assess changes in primary care provider (PCP) knowledge, comfort, confidence, perceived importance, and frequency of AD discussions.

Main Methods:

• A 16-week trial,
• Project Five Wishes,
• was conducted in a Northern Arizona primary care practice.

Main Results:

• The number of completed ADs increased by 25.4% during the trial.
• No statistically significant changes were observed in provider knowledge, comfort, confidence, perceived importance, or frequency of AD discussions.
• The intervention involved a provider presentation and integration of a user-friendly AD form into the clinic workflow.

Conclusions:

• The implemented process was effective in increasing AD documentation in primary care.
• The intervention's feasibility and reproducibility suggest potential for broader adoption in other clinics.
• While AD completion increased, provider-related factors did not show significant change in this trial.