Improving advance care planning completion in primary care through provider education and workflow redesign

Advance care planning (ACP) is a crucial process that empowers patients to clearly communicate their values, beliefs, and preferences regarding future medical care. This proactive approach ensures that their wishes are respected, particularly when they may be unable to make decisions for themselves. Advance care planning enables patients to articulate their values and preferences for future medical care. It aligns end-of-life care and reduces unnecessary interventions.

Despite the well-documented advantages of ACP, its completion rates remain consistently low across various health care settings. This issue is particularly pronounced within underserved and linguistically diverse populations, where systemic barriers, cultural sensitivities, and communication challenges often impede effective ACP engagement and documentation. Addressing this disparity is vital to ensure equitable access to patient-centered care.

Quality-improvement initiative was conducted in a multisite primary care practice. Knowles Adult Learning Theory guided provider education, and Plan-Do-Study-Act cycles supported workflow refinements.

Providers and medical assistants received targeted education, used standardized scripts, and engaged patients with multilingual, literacy-appropriate materials. Advance care planning discussions and documentation were monitored through biweekly chart audits over 6 months and analyzed using descriptive statistics.

Seventy-six of 150 chronic care management patients completed ACP documentation, all designating a health care proxy. Completions increased after a booster education session. Multilingual materials, standardized scripts, and workflow adaptations facilitated patient engagement.

Targeted provider education, structured workflows, and culturally sensitive outreach improve ACP completion in primary care. Nurses play a central role in ACP, supporting patient engagement, documentation, and culturally and linguistically appropriate care.