Approach to End-of-Life Care Planning in the Outpatient Setting

Purpose: Advance care planning (ACP) can prepare individuals to receive medical care aligned with their values and experience; however, ACP can be uncomfortable and taboo topic for many patients and thus, a time-consuming conversation for providers. As of 2017, only 1 in 3 of U.S. adults had any type of advanced care directive. Family Practice Associates of Abilene is a primary care clinic that serves an aging demographic with an increased need to address the issues of end-of-life care. Their short-term goal was to increase the initiation of advanced care planning (ACP) by patients 65+ years from October 1, 2021- December 17, 2021; the long-term goal is to see an increased follow-through of patients creating their ACP directives and documents. Methods: For the month of October all patients 65+ years were questioned regarding their ACP status and documented as: complete, desire to initiate, do not wish to initiate. Starting November 1, 2021, all patients 65+ years were first engaged with an educational pamphlet or conversation via the certified medical assistant or medical student prior to the physician encounter. Verbal confirmation of their ACP status was documented as: complete, desire to initiate, do not wish to initiate. Results: From November 1st - December 17th, there was a >70% increase in the verbal confirmation of the desire to initiate ACP from among eligible patients as compared to prior the implementation. In addition, many of the patients were encouraged to initiate follow-up of their concerns or questions by scheduling their Medicare Annual Wellness visit with the front office post-visit. Conclusion: This approach allowed for brief, multidisciplinary interactions around ACP that adapted to the time-limited care model seen in the outpatient setting1. Future steps could include reviewing the EMR system to quantify how many of the patients followed up on their verbal desire by scheduling a Medicare Annual Wellness exam.