Advance directives are legal documents developed as a tool to allow patients to express their wishes and allow healthcare providers to educate and converse with their patients on disease prognosis and management. Advance directives promote shared decision making, thus enhancing quality medical decisions, improving quality of care at end-of-life, and under certain circumstances, even decreasing healthcare costs by refusing aggressive treatment (Garrido, Balboni, Maciejewski, Bao, & Prigerson, 2015; Hickman & Pinto, 2014). In the United States, less than 30% of the population have a completed advance directive (De Vleminck et al., 2013; Dunlay, Swetz, Mueller, Roger, 2012). The purpose of this project was to increase advance directive rates by 20% at a rural clinic in patients older than 65 years of age with heart failure, stage IV cancer, end-stage renal disease, and/or chronic obstructive pulmonary disease. Advance directive rates and advance care planning facilitator rates were electronically gathered prior to two educational in-services. Educational in-services were given to a total of 24 healthcare professionals, and after each in-service, a confidence Likert scale survey was given to each participant. Four months after the first educational in-service, advance directive rates and advance care planning facilitators rates were electronically gathered. Four months after the first educational in-service, advance directive rates remained unchanged with 211 of 490 (43%) patients having an advance directive. A total of 11 advance care planning facilitator referrals were made. Confidence Likert scale surveys found the education increased participants’ knowledge of advance directives, confidence with initiating advance directive discussions, and likeliness of increasing advance care planning discussions.